Health Center Research Articles

Public Perception of the Food Estate Program of Cassava Cultivation as a Strategic Logistic Reserve in Realizing Regional Food Security in Gunung Mas Regency, Central Kalimantan

Gestational Diabetes Mellitus (GDM) is a collection of symptoms that arise in pregnant women caused by an increase in blood glucose levels due to a progressive decrease in insulin secretion, variables that influence the incidence of gestational diabetes include age, history of diabetes mellitus, can occur at any time, but this disease usually begins to attack in the 24th week of pregnancy. The prevalence of Gestational Diabetes Mellitus in Indonesia is still relatively small, namely around 3-5%, but this figure could be higher because cases of GDM are rarely detected. Even though it can heal on its own, that doesn't mean gestational diabetes is not dangerous. If not treated properly, this disease can increase the risk of the baby being born with excess weight, being born prematurely, or being born with low blood sugar or hypoglycemia. For pregnant women, gestational diabetes has the potential to cause complications, such as preeclampsia and hypertension. In Indonesia, all pregnant women are recommended to undergo DMG screening. However, not many pregnant women do this. The aim of this research is to determine the relationship between the perceptions of pregnant women and the behavior of early detection of Gestational Diabetes Mellitus at the Plumbon health center, Indramayu Regency in 2024. This research is quantitative research with a cross-sectional study design. The respondents in this study were 107 pregnant women who lived in the working area of the Plumbon Health Center, Indramayu Regency and used health services at the health center in 2024. Samples were taken using the Accidental Sampling technique, a technique for determining samples based on chance, namely any patient who happened to meet the researcher. and data were analyzed univariate and bivariate. The results of the research show that the characteristics of respondents, namely age, education, employment and income, do not have a significant relationship with early detection behavior of GDM, however, the perception of pregnant women with behavior of early detection of Gestational Diabetes Mellitus has a significant relationship as does mother's knowledge of early detection of Gestational Diabetes Mellitus. have a significant relationship.

Possibility of the optimum monitoring and evaluation (M&E) production frontier for risk-informed health governance in disaster-prone districts of West Bengal, India

An efficient M&E system in public healthcare is crucial for achieving universal health coverage in low- and middle-income countries, especially when the need for service remains unmet due to the exposure of the population to disaster risks and uncertainties. Current research has conducted exploratory and predictive analyses to estimate the determinants of sustainable M&E solutions for ensuring uninterrupted access during and after disasters. The aim was to estimate the efficiency of reaching a higher M&E production frontier via the Cobb‒Douglas model and stochastic frontier model as the basic theoretical and empirical frameworks. The research followed a deductive approach and used a stratified purposive sampling method to collect data from different layers of health and disaster governance in a flood-prone rural setting in the Malda, South 24 Parganas and Purulia districts in West Bengal, India. The present mixed-method study revealed multiple challenges in healthcare seeking during disasters and how a well-structured M&E system can increase system readiness to combat these challenges. The stochastic frontier model estimated the highest M&E frontier producing the most attainable M&E effectiveness through horizontal convergence between departments, enhanced coordination, the availability of frontline health workers at health centers, the adoption of learned innovation and the outsourcing of the evaluation component to external evaluators to improve M&E process quality. Although the study has several limitations, it shows the potential to increase technical and allocative efficiency through building skills in innovative techniques and applying them in process implementation. In the future, research on strategy improvement followed by real-world evidence-based policy advocacy is needed to increase the impact of M&E on access to healthcare services.

The Impact of Nurses Completing their Educational Attainment on the Health Services Provided to Patients and Reviews in Health Centers

This current study aims to know the impact of a nurse completing his educational attainment and its impact on the health services provided to society in general. It is also important to know the effect of completing his educational attainment on the quality of work and better dealing with patients and medical staff. It is also important to know its impact on increasing the organization of his time at work. Knowing its impact on increasing his efficiency in his work environment, A questionnaire was prepared via Google Drive and distributed to the population aged 25-55 years, men and women, in the city of Mecca. As for the questionnaire, it was distributed via the social networking program (WhatsApp) for the purpose of distancing for fear of the presence of the Corona virus. 400 questionnaires were distributed, and 395 responses were obtained via email to the principal researcher. The current study concluded that the impact of completing the educational attainment of male and female nurses and its impact on the health service provided was a very positive impact of 94.8%, and it also helped improve the health service provided to patients by a greater percentage of 90%.

The Association Between Direct Health Costs Related to Non-communicable Diseases and Physical Activity in Elderly People.

The aim of this study was to evaluate the association between direct health costs related to non-communicable diseases (NCDs) and the level of physical activity in Chinese elderly people. In this longitudinal study, 410 people over 64years old were selected from health centers. The direct health costs caused by NCDs were recorded on a weekly basis for a period of six months. Also, physical activity was measured using FitBit Flex2™ and as the number of daily steps as well as calories burned during this six month. The multiple linear regression analysis was used to identify the predictors of direct health costs caused by NCDs as the dependent variable. Age, gender, marital status, education level, currently working, Fitbit steps and calories, and BMI were entered into the model as predictor variables to perform a stepwise regression analysis. Four variables of age, BMI, Fitbit steps and Fitbit calories were able to enter the regression model. The model explained 24.8% of the variability of direct health costs due to NCDs. The strongest predictor of health costs was Fitbit calories (B = - 2.113, t = - 4.807, p < 0.001), followed by BMI (B = 1.267, t = 3.482, p < 0.001), Fitbit steps (B = - 1.157, t = - 3.118, p < 0.001), and age (B = 1.115, t = 2.599, p < 0.001). It can be said that having regular physical activity can reduce health costs due to NCDs in Chinese older people.

Medical Demography and Access to Prenatal Care in the Foumbot Agricultural Production Basin (West Cameroon)

This article analyzes the dynamics of medical demography and access to prenatal care in the agricultural production basin of Foumbot, located in western Cameroon. This region, characterized by strong agricultural activity, presents particular challenges in terms of maternal and child health. Lack of adequate access to prenatal care is a major concern that can influence maternal and neonatal health indicators. In our work, we conducted a six-month study in the commune of Foumbot. We used a research methodology that included multidimensional analysis, drawing on data from field surveys of 140 randomly selected women in the villages of Baigom, Fosset, Foumbot 1, 2, 3, 4, 5, Maka, Momo and Njone. These data were analyzed using descriptive statistical techniques. This enabled us to highlight the variation in qualities of prenatal care according to environments and types of health facility. The results show a significant disparity in access to prenatal care according to different socio-economic and geographical factors. Only 70% of pregnant women made the minimum four visits required, 22% did not use prenatal care, while 8% had fewer than four visits. The study also reveals that the main obstacles are the remoteness of health centers, the costs associated with cares and cultural practices that can limit the use of available services. The impact of agricultural activity, which is often the main source of income and subsistence for local populations, exacerbates these challenges by reducing the time available for medical care and increasing economic constraints. In rural areas, the use of medicinal plants also predominates, at 30%. The maternal mortality rate rose from 20 to 25 deaths per 100,000 live births between 2020 and 2023. Life expectancy at birth is 56 years; the infant mortality rate is 54‰, and the adult literacy rate is 63%. This research sheds light on the challenges faced by rural populations in terms of prenatal cares, and proposes concrete avenues for strengthening the healthcare system in similar contexts. The results of this study could also serve as a reference for public health policies aimed at improving access to care in other rural areas of Africa.

EVALUATING THE EFFECTIVENESS OF KAYAKALPA PRACTICES AMONG HEALTHCARE WORKERS IN SOUTH ZONE PHCs OF BENGALURU DISTRICT: A CROSS-SECTIONAL STUDY

Background: Kayakalpa practices, introduced under the Swachh Bharat Abhiyan, focus on improving cleanliness, hygiene, and infection control in healthcare facilities. Evaluating their effectiveness, particularly among healthcare workers (HCWs), is crucial for ensuring these objectives are met. Objective: This study aims to evaluate the awareness, adherence, and perceived effectiveness of Kayakalpa practices among healthcare workers in the South Zone PHCs of Bengaluru District, as well as to identify the factors influencing these outcomes. Methods: A cross-sectional study was conducted among 200 healthcare workers from selected PHCs in the South Zone of Bengaluru, using stratified random sampling to ensure representation across different job roles. A structured questionnaire was administered to assess awareness, adherence, perceived effectiveness, and barriers to adherence. Data were analyzed using SPSS software, employing descriptive statistics, chi-square tests for associations, correlation analysis, and multiple regression analysis to identify predictors of adherence and perceived effectiveness. Results: Awareness of Kayakalpa practices was high, with 75% of participants reporting knowledge of the guidelines. However, adherence was lower at 55%. Chi-square tests revealed significant associations between job role and adherence (χ² = 12.34, p &lt; 0.05), and between perceived effectiveness and the frequency of training (χ² = 9.67, p &lt; 0.01). Correlation analysis showed a significant positive relationship between awareness and adherence (r = 0.45, p &lt; 0.01). Multiple regression analysis revealed that both awareness (β = 0.35, p &lt; 0.05) and availability of resources (β = 0.28, p &lt; 0.05) were significant predictors of adherence. Perceived effectiveness was significantly associated with adherence (β = 0.42, p &lt; 0.01) and regular training (β = 0.31, p &lt; 0.05). Discussion: The study highlights a gap between awareness and adherence to Kayakalpa practices among HCWs, with adherence being influenced by both awareness and resource availability. The effectiveness of the practices was found to be closely linked to adherence and the provision of continuous training. The chi-square analysis underscores the role of job role and training frequency in adherence and perceived effectiveness. Conclusion: While awareness of Kayakalpa practices is relatively high, adherence remains a challenge, limiting the overall effectiveness of the initiative. Targeted interventions, including regular training and improved resource allocation, are necessary to enhance adherence and maximize the impact of these practices on hygiene and infection control in PHCs. KEYWORDS: Kayakalpa, healthcare workers, primary health centres, awareness, adherence, infection control, multiple regression, chi-square

The Role of The Cirebon Regency Government In Controlling Population Growth Which Continues To Increase

The aim of this research is to determine the extent of the role and programs of local governments in dealing with ever-increasing population growth. With the broadcast of population numbers, it will become a serious problem faced by several regions in Indonesia, especially in Cirebon Regency. In the process of reducing the increase in population growth, the regional government has made several policies including the Family Planning Program, the provision of contraceptive medication in every Public Health Center and Hospital as well as private sector, PIKR Program, and the SIGA Application. As well as providing communication, information and education, it has been carried out through community groups with coordination from the technical implementation unit to the community. This study takes a descriptive approach while utilizing a qualitative strategy. The data collected was direct interviews with informants.

Examining Financial Strain and Subjective Social Status in Terms of Behavioral Health Among Latinx Adults in a Federally Qualified Health Center.

There is a growing recognition that Social Determinants of Health (SDoH) can inform some sources of physical and mental health disparities among the Latinx population. The current study sought to expand previous research by exploring the singular and interactive influence of financial strain and subjective social status-two common and clinically important SDoH factors-on pain intensity, pain disability, general depression, social anxiety, and anxious arousal. The current sample consisted of 155 Latinx adults (81.3% female; Mage = 40.02years, SD = 10.61) presenting for care at a Federally Qualified Health Center (FQHC). Multivariate results demonstrated that financial strain was statistically significantly associated with greater pain intensity, pain disability, general depression, and anxious arousal, but not social anxiety. Further, lower subjective social status was related to greater general depression, social anxiety, and anxious arousal but not with higher levels of pain indices. An interactive effect was found wherein the combination of higher levels of financial strain and low levels of subjective social status was related to general depression and anxious arousal. This is the first study to empirically evaluate the main and interactive effects of financial strain and subjective social status regarding numerous physical and mental health symptoms. These findings clarify how two prevalent SDoH factors influence health outcomes. Specifically, the results suggest that a multi-risk conceptualization can advance a fine-grained understanding of Latinx health disparities by showing differential associations between SDoH factors and clinical outcomes that are frequently the source of health inequities in the Latinx population.

Observed Versus Predicted Vaginal Birth After Cesarean for Patients of a Community Health Center.

The Maternal-Fetal Medicine Units Network calculator for vaginal birth after cesarean (VBAC) probability was updated to exclude a race and ethnicity variable, but its impact on marginalized groups is unknown. We assessed the tool with attention to birth history and body mass index (BMI) in a predominately Hispanic cohort and examined the possible effect of discouraging labor after cesarean (LAC) with a low score. We conducted a retrospective cohort study of LACs by patients who entered spontaneous or induced labor with a live, nonanomalous fetus in cephalic presentation between 2012 and 2022. Observed VBAC rates were compared with the mean predicted VBAC probability derived from the calculator. Areas under the curve (AUCs) were calculated for the entire cohort and for individuals with LAC with and without prior vaginal birth. A z-test was used to determine the significance between VBAC rates in 4 BMI categories. The impact of discouraging LAC with VBAC probability below 70% was examined. A total of 400 people experienced 507 LACs, with 417 (82.2%) resulting in VBAC compared with a mean predicted probability of 71.2%. The AUC for all LACs was 0.76 (95% CI, 0.71-0.81), whereas the AUC for LACs with prior vaginal birth was 0.70 (95% CI, 0.56-0.85) and without was 0.60 (95% CI, 0.52-0.67). Observed VBAC rates exceeded predicted rates for individuals with overweight and obese BMIs: <25 (79.6% vs 75.6%; P =.520), 25 to 30 (83.2% vs 71.9%; P =.007), 30 to 40 (82.7% vs 70.0%; P =.004), and ≥40 (82.8% vs 58.3%; P =.040). Discouraging LAC below 70% probability might have prevented 71 unsuccessful LACs, 160 initial VBACs, and 57 subsequent VBACs, decreasing the VBAC rate to 39.4% (200/507). In a predominately Hispanic cohort, the updated calculator underestimated VBAC potential for people with no vaginal birth history and/or an elevated BMI. Discouraging LAC based on low VBAC probability may prevent both initial and subsequent VBACs.

Extent and causes of unused medications among patients in rural Ethiopia: a prospective multicenter cohort study

BackgroundMedication waste poses health, economic, and environmental challenges. However, the extent among patients living in rural areas is underexplored. This study assessed the proportion of prescribed medications remaining unused by patients living in rural areas of Ethiopia, and identify the causes thereof and disposal practices.MethodsA prospective multicenter cohort study was conducted in 5 rural health centers in Ethiopia. Patients (≥ 18 years), who received a prescription for acute or chronic medication for pick up from the outpatient pharmacy were included. After 3 months, participants received a house visit by a health employee during which a questionnaire was verbally administered to assess the quantity of unused medication, reason thereof, and disposal practices used. Data were analyzed using descriptive statistics and multivariate logistic regression to identify factors associated with presence of unused medications.ResultsIn total, 178 patients participated. Up to 136 out of 601 (22.6%) dispensed medications ended up unused, mainly antibiotics and analgesics, with an average economic value of $0.37. Of 178 patients, 72 (40.4%) ended up with unused medication, and 15 (8.4%) did not use 80% or more of the prescribed quantity. Early discontinuation of therapy was the main reason (61.8%) for patients’ ending with unused medication. Patients reported to primarily dispose of unused medication either through the toilet (43.6%), household garbage (22.7%), burning (13.6%), or returning it to the pharmacy (2.7%). Medications dispensed to be administered with two or more-unit doses at a time were more likely to remain unused (adjusted OR 1.6 [1.0–3.4]) compared to medications dispensed to be administered one-unit dose.ConclusionA substantial amount of prescribed medications remains unused by patients in rural areas, frequently not properly disposed. Interventions are needed to ensure medications are not wasted and reduce the unwanted consequences.

Level of institutional delivery service utilization and associated factors among women who gave birth in the past 12 months, Ga’an libah district, Marodijeh region, Somaliland: a community-based cross-sectional study

BackgroundInstitutional delivery has been considered one of the important strategies to improve maternal and child health and significantly reduce birth-related complications. However, it is still low in developing countries though there are some improvements. even among the community who has access to the health institutions weather health center and hospital including Somaliland. Hence, the aim of this study was to assess the level of institutional delivery service utilization and associated factors among women who gave birth in the last 12 months in Ga’an libah district, Marodijeh region, Somaliland.MethodsThe community-based cross-sectional study was conducted among women who gave birth in the last 12 months from September to December 2022. A simple random sampling technique was employed to select study participants from a total of sample population. Data was collected using semi-structural administered questionnaire through interviewing women. Data was collected with online mobile data collection (Kobo collect). SPSS version 25.0 was used for data management, entering and analysis. Bivariate and multivariable logistic regression models were fitted to determine the presence of a statistically significant association between independent variables and the outcome variable with p-value < 0.05.ResultLevel of Institutional delivery services utilization in Ga’an libah district was 53.9% [95% Cl 48.2–59.6] gave birth at health institutions. Women who can read and write local were (AOR 2.18, 95% CI 1.08–4.56, p<0.01), Women with their husband can be capable to read and write are [(AOR = 6.95, 95% Cl 2.82–21.58, p<0.002]). Additionally, ability to cost transportation for referral [AOR 5.21, 95% Cl 2.44–11.13, p<0.001]. not good services available [AOR 0.07, 95%Cl 0.01–0.10, p<0.02]. lack of maternal health and child knowledge [AOR 0.034, 95% Cl 0.02–0.57, p<0.01]. were observed associated with level of institutional deliver services utilization.ConclusionThe institutional delivery service utilization was relatively high compared to national demographic health services in the study area. A large proportion of women gave both at home without a skilled attendant. Therefore, this finding has important policy implications since changes in the cost of the health service and perceived quality would mean changes in client satisfaction as well as their choice, as well emphasize to expectant women can receive medical advice and ambulance for referrals.

Feasibility, acceptability and preliminary evaluation of a user co-facilitated psychoeducational programme: a feasibility proof-of-concept randomised control trial

BackgroundMental health settings are increasingly using co-facilitation of educational group interventions in collaboration with patient partners and service users. However, despite promising results, limited information is available regarding the feasibility and satisfaction levels of these programmes among adults newly diagnosed with attention-deficit hyperactivity/impulsivity disorder (ADHD). Hence, this study aimed to determine the feasibility, acceptability, and preliminary effects of a user co-facilitated psychoeducational group programme for adults diagnosed with ADHD.MethodsThis feasibility proof-of-concept randomised controlled trial recruited outpatients from a Norwegian community mental health centre. Outpatients randomised to the intervention group (IG) received a psychoeducational programme supplementing Treatment As Usual (TAU), while the control group received TAU. Feasibility was determined by the acceptance rate, adherence rate, and dropout rate. Acceptability was measured with the Client Satisfaction Questionnaire and a 3-item scale measuring satisfaction with the received information. To test the preliminary effects, self-efficacy, symptom severity, and quality of life were measured at baseline and pre- and post-intervention.ResultsFeasibility was demonstrated; most of the patients were willing to enrol, participants attended 82% of the psychoeducational programme, and only 13% dropped out of the study. The between-group analyses revealed that the IG reported significantly greater mean satisfaction than the CG. Moreover, the intervention group was more satisfied with the information they received during the psychoeducational programme. Concerning the preliminary effects, the linear mixed model showed improvement in quality of life (the subscale relationship); however, other patient-reported outcomes did not show improvements.ConclusionsThis proof-of-concept randomised controlled trial supports the feasibility and acceptability of the user co-facilitated psychoeducational programme for patients newly diagnosed with ADHD in an outpatient setting. While preliminary findings indicate promise in enhancing patient-reported outcomes, a larger study is warranted to assess the intervention’s effectiveness rigorously.Trial registrationNCT03425, 09/11/2017.

Nurses, Knowledge, Attitude and Practices toward Covid-19 in Maternal and Child Health Centers at Assiut city.

Nurses, Knowledge, Attitude and Practices toward Covid-19 in Maternal and Child Health Centers at Assiut city.

Transcultural adaptation and validation of Persian Version of Patient Assessment of Chronic Illness Care (PACIC-5As) Questionnaire in Iranian older patients with type 2 diabetes

BackgroundThe Patient Assessment of Chronic Illness Care (PACIC-5As) questionnaire has been designed to evaluate the healthcare experiences of individuals with chronic diseases such as diabetes. Older adults are at higher risk for diabetes and its associated complications. The aim of this study was transcultural adaptation and evaluation of the validity and reliability of the PACIC-5As questionnaire in older patients with diabetes residing in Qazvin City, Iran.MethodIn this validation study, we recruited 306 older patients with diabetes from Comprehensive Health Centers in Qazvin, Iran. The multi-stage cluster sampling technique was used to choose a representative sample. The PACIC-5As questionnaire was translated into Persian using the World Health Organization (WHO) standardized method. The validity (face, content, and construct) and reliability (Cronbach’s alpha) of the PACIC-5As were assessed. Data analysis was conducted using R software and the Lavaan package.ResultsThe mean age of the older patients was 69.99 ± 6.94 years old. Most older participants were female (n = 180, 58.82%) and married (n = 216, 70.59%). Regarding face validity, all items of PACIC-5As had impact scores greater than 1.5. In terms of content validity, all items had a content validity ratio > 0.49 and a content validity index > 0.79. The results of confirmatory factor analysis demonstrated that the model exhibited satisfactory fit across the expected five factors, including assess, advise, agree, assist, and arrange, for the 25 items of the PACIC-5As questionnaire. The Cronbach’s alpha coefficient for the PACIC-5As questionnaire was 0.805.ConclusionThis study indicates that the Persian version of the PACIC-5As questionnaire is valid and reliable for assessing healthcare experiences in older patients with diabetes. This means that the questionnaire can be effectively used in this population.

Recommendations to Address Barriers to Patient Portal Use Among Persons With Diabetes Seeking Care at Community Health Centers: Interview Study With Patients and Health Care Providers.

Community health centers (CHCs) are safety-net health care facilities in the United States that provide care for a substantial number of low-income, non-English speaking adults with type 2 diabetes (T2D). Whereas patient portals have been shown to be associated with significant improvements in diabetes self-management and outcomes, they remain underused in CHCs. In addition, little is known about the specific barriers to and facilitators of patient portal use in CHCs and strategies to address the barriers. The objectives of this qualitative study were to explore the barriers to and facilitators of the use of patient portals for managing diabetes in 2 CHCs from the perspective of adults with T2D and clinicians (community health workers, nurses, nurse practitioners, and physicians) and to make recommendations on strategies to enhance use. A qualitative description design was used. A total of 21 participants (n=13, 62% clinicians and n=8, 38% adults with T2D) were purposively and conveniently selected from 2 CHCs. Adults with T2D were included if they were an established patient of one of the partner CHCs, aged ≥18 years, diagnosed with T2D ≥6 months, and able to read English or Spanish. Clinicians at our partner CHCs who provided care or services for adults with T2D were eligible for this study. Semistructured interviews were conducted in either Spanish or English based on participant preference. Interviews were audio-recorded and transcribed. Spanish interviews were translated into English by a bilingual research assistant. Data were collected between October 5, 2022, and March 16, 2023. Data were analyzed using a rapid content analysis method. Standards of rigor were implemented. Themes generated from interviews included perceived usefulness and challenges of the patient portal, strategies to improve patient portal use, and challenges in diabetes self-management. Participants were enthusiastic about the potential of the portal to improve access to health information and patient-clinician communication. However, challenges of health and technology literacy, maintaining engagement, and clinician burden were identified. Standardized implementation strategies were recommended to raise awareness of patient portal benefits, provide simplified training and technology support, change clinic workflow to triage messages, customize portal notification messages, minimize clinician burden, and enhance the ease with which blood glucose data can be uploaded into the portal. Adults with T2D and clinicians at CHCs continue to report pervasive challenges to patient portal use in CHCs. Providing training and technical support on patient portal use for patients with low health literacy at CHCs is a critical next step. Implementing standardized patient portal strategies to address the unique needs of patients receiving care at CHCs also has the potential to improve health equity and health outcomes associated with patient portal use.

Experiences and ethical issues during shared decision-making in healthcare at rural health facilities in Uganda: An exploratory qualitative study.

Background: Shared decision-making in healthcare is a collaborative process where patients are supported to make informed decisions according to their preferences. Healthcare decisions affect patients' lives which necessitates patients to participate in decisions concerning their health. This study explored experiences and ethical issues related to shared decision-making in a rural healthcare setting. Methods: An exploratory qualitative study was conducted at Budumba Health Centre III and Butaleja Health Centre III in rural Eastern Uganda. In this study, 23 in-depth interviews were conducted among 12 healthcare providers and 11 patients. Data was analyzed thematically using NVivo-12 plus software. Results: Four themes emerged which included: experiences, challenges, strategies for improvement, and ethical issues. Patients at both facilities expressed the need to be involved in decision-making processes. However, many stressed that they are not engaged in decision-making about their health. Many healthcare providers noted that shared decision-making could improve patient prognosis but are faced with challenges related to low male involvement and the influence of cultural and religious practices, including myths and patriarchal attitudes which impact effective patient engagement. Ethical issues included concerns about informed consent, privacy and confidentiality, deception, and harm. This study highlighted the need for better sensitization of patients and comprehensive training for HCPs to minimize and resolve ethical issues that emerge during shared decision-making processes. Conclusions: There is a need for targeted interventions to enhance decision-making processes in rural healthcare including but not limited to developing shared decision-making manual and continuous training of healthcare providers to ethically engage patients. Further research is needed to explore larger facilities with a bigger scope including patients under 18 years of age and and their surrogates.

Expert System for Pregnancy Risk Diagnosis Using Decision Tree and Dempster-Shafer Method

The high Maternal Mortality Rate (MMR) remains a severe concern in maternal healthcare. One of the reasons is the delay in recognizing early danger signs during pregnancy. To address this issue, there is a proposed solution in the form of developing an expert system aimed at swiftly and efficiently diagnosing pregnancy risks in pregnant women using the Decision Tree and Dempster Shafer methods. The Decision Tree method is employed for symptom classification, while Dempster Shafer provides confidence values for existing facts. This research collects data from the dataset, the Poedji Rochjati Score Card (KSPR), and qualitative data through expert interviews. From the collected data, knowledge acquisition processes are then carried out to extract knowledge using the ID3 Decision Tree and combine all symptoms from the gathered data. The processed data is then represented as a decision tree and assigned confidence values. The development of this expert system utilizes the Laravel framework with PHP language and MySQL database. System validation involves patients as participants and midwives as experts and testers. Testing was conducted on March 13 and 16, 2024, involving 16 patients at the Gatak Community Health Center. The system evaluation results show an accuracy rate of 93.75%. This value indicates that the system can operate effectively. Thus, it can be recommended for use in diagnosing pregnancy risks.

Organizational resilience and primary care nurses' work conditions and wellbeing: a multilevel empirical study in China.

Resilience is crucial for the health system better preventing and responding to public health threats and providing high-quality services. Despite the growing interest in the concept of resilience in health care, however, there is little empirical evidence of the impact of organizational resilience, especially in primary care settings. As the largest professional group in primary care, primary care nurses are taking more and more responsibilities during their daily practice, which influences both their work conditions and wellbeing. This study aims to examine the association between organizational resilience and primary care nurses' working conditions and wellbeing. Using a convenience sampling approach, we recruited 175 primary care nurses from 38 community health centers (CHCs) in four cities in China. Organizational resilience was operationalized as comprising two domains: adaptive capacity and planning capacity, and measured using a 16-item scale. The primary care nurses' working condition indicators comprised variables of psychological safety, organizational commitment, professional commitment, and self-directed learning; wellbeing indicators included depression and burnout. Hierarchical linear regression models were built for analysis. We found that the sampled CHCs have a relatively high level of organizational resilience. The organizational resilience was positively associated with the four indicators of working conditions: psychological safety (β=0.04, p<0.01), organizational commitment (β=0.38,p<0.01), professional commitment (β=0.39, p<0.01), and self-directed learning (β=0.28, p<0.01). However, organizational resilience was not significantly associated with the two wellbeing indicators. Furthermore, we found the adaptive capacity has stronger association compared with planning capacity. Therefore, primary care manager should build resilient organizations, especially the adaptive capacity, in order to enhance primary care nurses' psychological safety, commitment and learning behaviors. Further studies should also be conducted to understand the link between organizational resilience and primary care nurses' wellbeing.

The effect of an educational intervention on healthy lifestyle knowledge and behaviour among middle-aged women

Objectives: This study aimed to assess the impact of an educational intervention on middle-aged women’s knowledge and behaviour regarding various aspects of a healthy lifestyle. Design: Quasi-experimental study involving 150 middle-aged women (divided into experimental and control groups). Setting: Participants were selected from health centres of Tehran, Iran. Method: Data collection included demographic information, knowledge of a healthy lifestyle and healthy lifestyle behaviour. Participants in both the intervention and control groups completed the questionnaires before and 2 months after the educational intervention. The intervention involved 10 minutes of face-to-face training followed by distribution of training booklets provided by the Ministry of Health in Iran. Statistical analyses were conducted using SPSS. Results: Within the intervention group, significant differences were observed in total healthy lifestyle knowledge and subscales for physical activity knowledge, anthropometry knowledge, healthy diet knowledge, and smoking knowledge, between the pre- and post-intervention periods. Other than for smoking behaviour, there was no significant difference in healthy behaviours pre- and post-intervention for the experimental and also the control group. Conclusion: While there was an increase in knowledge about healthy lifestyles following the intervention, this knowledge increase was not associated with a change in healthy lifestyle behaviours. Attention should therefore be given to other influences including socio-economic factors, mental health status, environmental factors, cultural influences, duration of the intervention and psychological factors if changes in healthy behaviour are to be achieved.

Unraveling the drivers of inequality in primary health-care resource distribution: Evidence from Guangzhou, China

BackgroundPrimary health-care (PHC) resource plays a critical role in addressing challenges related to healthcare accessibility and costs, as well as implementing a graded diagnosis and treatment system. This study aims to analyze the extent and components of inequality in PHC resource allocation in Guangzhou. MethodsBy utilizing data from the Annual Report on Healthcare Institutions for community and township health centers in Guangzhou from 2012 to 2020, this paper analyses the distribution of human, material and financial resources. It examines inequities in health resource allocation using the Gini coefficient. Additionally, it investigates the internal structure of overall inequality through the two-stage nested Theil decomposition method and explores the influencing mechanisms of inequality using the concentration index decomposition method. ResultsThe findings indicate that between 2012 and 2020, except for beds in 2018 and 2019, the Gini coefficients for resource allocation relative to population size remained below 0.3. Moreover, the Gini coefficient for geographical area ranged from 0.1228 to 0.3481. The two-stage nested Theil decomposition results reveal that within-district disparity contributes the most to the overall inequality, exceeding 46 %. The Concentration indexes show negative values, and the decomposition analysis highlights the significant contribution of the number of individuals served (over 72 %) to the inequality in health resource allocation. ConclusionAt the administrative district level, the allocation of PHC resources in Guangzhou demonstrates overall equity, with within-district inequality identified as the primary contributor to the overall inequality. The distribution of PHC resources in Guangzhou follows a pro-poor pattern. The key factors influencing equity enhancement in PHC resource allocation in Guangzhou include the number of individuals served, the presence of township health centers among institution types, the number of hospital admissions per capita, and the proportion of children aged 0–3.