Health Seeking Behaviour Research Articles

Factors Associated with Mothers Health Seeking Behavior among Newborn Illness.

Inappropriate, delayed and poor health seeking behavior increases the high risk of morbidity and mortality among newborns, infants and children. Newborns health status depends upon mothers' health seeking behavior. This study aimed to determine the factors associated with mother's health seeking behavior among newborn illness in Rupandehi District, Nepal. Community based cross-sectional study among 372 mothers aged 15-49 years was conducted in Rupandehi district Nepal from May to November 2019. Multistage probability random sampling was used as the sampling technique. Siddharthanagar municipality and Mayadevi rural municipality were selected randomly among 16 local units of Rupandehi district. Two wards from each unit were selected by stratified random sampling using non replacement lottery method. As the sample size was 372, ninety three respondents were selected randomly from each ward. The mean age and standard deviation of mothers was 25.32±4.36 years respectively. Among 372 mothers, 21.24% had poor health seeking behavior. Mothers having more than one child (AOR=0.15; CI: 0.02-0.98), primary and above education (AOR=8.89; CI: 3.15-25.08), visited hospital after 24 hours of newborn illness (AOR=13.59; CI: 1.73-106.7), knew danger signs of newborn (AOR=18.74; CI: 5.65-62.23), practiced exclusive breastfeeding (AOR=8.20; CI: 3.36-20.03) were significantly associated with health seeking behavior. Almost 22 % of mothers had poor health seeking behavior regarding their newborn illness. Number of living child, education of mother, appropriate time for treatment, receive health services when there is dangers signs of newborn and exclusive breast feeding practice were independent factors associated with mother's health seeking behavior. Hence, decision-makers and local administrator should provide specific intervention to newborns' mother regarding family planning, identifying and preventing danger signs of newborn, importance of appropriate time of treatment and exclusive breastfeeding.

Abstract 1310: Social determinants of migrant health factors impacting prostate cancer care and survivorship among sub-Saharan African immigrant men diagnosed with prostate cancer

Abstract Background: Sub-Saharan African Immigrants (SSAI) represent one of the fastest-growing segments of the immigrant population in the United States (US). Between 2010 and 2018, the SSAI population in the US increased by 53%, significantly outpacing the 12% growth rate for the overall foreign-born population in the US during that time frame. Despite these growing numbers, little is published about the extent to which SSAIs adapt to health behaviors more common in the US or remain immersed in the values, beliefs and practices reflective of their country of origin. Importantly, no study has comprehensively examined the Social Determinants of Health (SDOH) among this population relative to their migration experiences and their influence on health-seeking behaviors and decision-making regarding prostate cancer care and treatment options. Methods: This qualitative study employed grounded theory and the social determinants of migrant heath framework to better understand the needs of SSAI prostate cancer survivors in the United States and how to effectively support these survivors. In-depth interviews were conducted with 8 survivors who live in the states of Florida and Minnesota. Findings: Some participants reported limited access to care and financial challenges paying for drugs. In terms of coping with diagnosis and treatment, most of the participants relied on their faith, a positive outlook about survivorship and support of family members. Some participants relied on the coaching and support of a loved one who experienced prostate cancer in the past. Erectile dysfunction severely impacted the sexual life of most participants as they experienced difficulty getting an erection. Conclusion: Participants expressed the benefit of belonging to support groups with other survivors for social and emotional support. As the number of immigrants from sub-Saharan continue to rise, so too will the demand for culturally tailored care to address and reduce disparities in survivorship among this sub-population. Citation Format: Ernest Kaninjing, Gladys Asiedu, Kaitlin Van Voorhis, Mary Ellen Young, Ebenezer Erefah, Emmanuel Agboola, Folakemi Odedina, Roxana Dronca, Kimlin Ashing, Solomon Rotimi, Che Ngufor, Arnola Merriweather, John McCall, Anthony Hill. Social determinants of migrant health factors impacting prostate cancer care and survivorship among sub-Saharan African immigrant men diagnosed with prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 1310.

Abstract 2209: Tattooing and risk of melanoma: A population-based case-control study in Utah

Abstract Background: Carcinogens have been observed in many tattoo inks which can form new carcinogenic compounds when exposed to ultraviolet radiation and can accumulate in the lymph nodes and other organs. Tattooing can result in short- and long-term inflammatory and immune responses. At least 38 cases of melanoma have been reported in tattoos. The incidence of melanoma in Utah is the highest in the U.S., and potentially modifiable risk factors are of public health interest. In this study, we evaluated associations between tattooing and melanoma risk. Methods: We utilized a population-based case-control study of 514 incident in situ (284 men and 230 women) and 534 invasive (285 men and 249 women) melanoma cases diagnosed in Utah between 2020-2021. Controls (n=5,240) were selected from respondents to the Utah Behavioral Risk Factor Surveillance System (BRFSS) survey and frequency matched to cases in a 5:1 ratio on sex, age, race, and ethnicity. We fit logistic regression models to compute odds ratios (ORs) and 95% confidence intervals (CIs) associating ever tattooing with in situ and invasive melanoma risk, adjusting for age, education level, race, and ethnicity, separately for women and men. We then fit logistic models stratified by education level (< four-year college degree/four-year college degree or more) and models stratified by age (< 50 years/50+ years), separately for women and men. Results: Among men, the prevalence of tattooing was 7% for both in situ and invasive cases, and 11% for controls. Among women, tattooing prevalence was 20% for in situ cases, 15% for invasive cases, and 18% for controls. Ever tattooing was associated with decreased invasive melanoma risk among men (OR=0.62 [95% CI: 0.37-1.02]), particularly among those who had less than a four-year college degree (0.52 [0.28-0.99]), and among ages 50+ (0.36 [0.16-0.84]). Among men, the OR for ever tattooing and in situ melanoma was in the same direction as invasive melanoma, but the estimate was statistically imprecise (0.73 [0.45-1.19]). Among women, we did not observe an association between ever tattooing and invasive melanoma (0.83 [0.56-1.20]), while the association between ever tattooing and in situ melanoma was statistically imprecise (1.25 [0.87-1.80]). However, ever tattooing was associated with a nearly two-fold increased risk of in situ melanoma among women with a four-year college degree (1.98 [1.21-3.26]), but not for those without a college degree (0.89 [0.52-1.50]). Conclusion: These findings do not suggest that there is an association between tattooing and melanoma. Associations between tattooing and health-seeking behaviors, which may vary by sex and other demographic factors, may influence associations with melanoma diagnosis, particularly for in situ melanoma. This study is the first step in investigating whether reported cases of melanoma arising in tattoos are coincidental or whether tattoos may be associated with an increased risk of melanoma. Citation Format: Rachel D. McCarty, Britton Trabert, Morgan M. Millar, David Kriebel, Laurie Grieshober, Mollie E. Barnard, Lindsay J. Collin, Katherine A. Lawson-Michod, Jeffrey A. Gilreath, Douglas Grossman, John Hyngstrom, Paul J. Shami, Jennifer A. Doherty. Tattooing and risk of melanoma: A population-based case-control study in Utah [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2209.

Abstract 2246: The impact of a waitlist control group on physical activity level in the activity after cancer treatment exercise oncology randomized pilot study

Abstract Background: In randomized clinical trials, control conditions such as blinding are essential for mitigating threats to validity. In exercise oncology trials, researchers are unable to blind participants to randomization, which may confer unintended consequences (i.e., crossover or dropout) that may threaten validity. Despite prior suggestions that a waitlist control is optimal for lessening these consequences, to date there is little agreement concerning control conditions in exercise oncology. Further, the use of a waitlist control is complicated by concerns regarding the ethical implications of instructing participants to delay healthy behavior change. Herein, we leveraged data from the Activity after Cancer Treatment (ACT) study to evaluate the impact of randomization to a waitlist control group on objectively assessed physical activity (PA) levels in breast cancer (BC) survivors. Methods: The ACT Study (PI: Ambrosone) was a 12-week, four-arm pilot study at Roswell Park Comprehensive Cancer Center. Participants included 37 BC survivors who were randomized to either a waitlist control group (n=10), or one of three exercise interventions of varying intensities including home-based walking (n=9), home-based Zumba (n=9), or a supervised high-intensity interval training treadmill protocol (n=9) delivered by study personnel at Roswell Park Comprehensive Cancer Center. The waitlist group was asked to maintain their usual PA during the 12-week intervention. All participants received weekly phone calls to optimize engagement and ensure Fitbit data were properly synced. For the current analysis, the primary analytic exposure was randomization assignment (control or active intervention); the analytic outcomes included steps/day, moderate-to-vigorous PA (MVPA) minutes/week and total active minutes/week as measured by the Fitbit Charge 2. ANOVA was used to assess mean group differences in steps and active minutes. Results: At study conclusion, the control group accumulated significantly fewer steps/day [6,087 (±1,353)] than the active intervention groups [8,729 (±2,585), p=0.0003]. The control group also accumulated significantly fewer MVPA minutes/week [146.2 (±114.9) vs. 264.1 (±192.3), p=0.045] and total active minutes/week [1,478 (±291.0) vs. 1,976.8 (±658.6), p=0.003] in comparison to the active intervention groups, respectively. Conclusions: BC survivors randomized to active intervention accumulated significantly more steps, MVPA and total active minutes than the waitlist group. Although the waitlist was effective for minimizing PA relative to the active arms, waitlisted participants exceeded the national step average of 4800 steps/day by 1200 steps and nearly met the minimum PA recommendation of 150 minutes of MVPA/week, potentially assuaging ethical or public health concerns regarding the delay of health-seeking behavior. Citation Format: Rikki Cannioto, Evan Davis, Karen Hulme, Chi-Chen Hong, Carol DeNysschen, Tracey O'Connor, Christine Ambrosone. The impact of a waitlist control group on physical activity level in the activity after cancer treatment exercise oncology randomized pilot study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2246.

Examining Health-Seeking Behavior among Diverse Ethnic Subgroups within Black Populations in the United States and Canada: A Cross-Sectional Study.

The Black populations, often treated as ethnically homogenous, face a constant challenge in accessing and utilizing healthcare services. This study examines the intra-group differences in health-seeking behavior among diverse ethnic subgroups within Black communities. A cross-sectional analysis included 239 adults ≥18 years of age who self-identified as Black in the United States and Canada. Multiple logistic regression assessed the relationship between health-seeking behaviors and ethnic origin, controlling for selected social and health-related factors. The mean age of the participants was 38.6 years, 31% were male, and 20% were unemployed. Sixty-one percent reported a very good or excellent health status, and 59.7% were not receiving treatment for chronic conditions. Advancing age (OR = 1.05, CI: 1.01-1.09), female gender (OR = 3.09, CI: 1.47-6.47), and unemployment (OR = 3.46, CI: 1.35-8.90) were associated with favorable health-seeking behaviors. Compared with the participants with graduate degrees, individuals with high school diplomas or less (OR = 3.80, CI: 1.07-13.4) and bachelor's degrees (OR = 3.57, CI: 1.3-9.23) were more inclined to have engaged in favorable health-seeking behavior compared to those with graduate degrees. Across the Black communities in our sample, irrespective of ethnic origins or country of birth, determinants of health-seeking behavior were age, gender, employment status, and educational attainment.

Health-seeking behavior in Indonesia especially in outer Baduy ethnic with heart disease

Background: Unlike the community in general, the Baduy community in Kanekes Village has a unique way of looking at the modern world, including their sight of modern medicine. Even though they know traditional medicine, in the current context, their traditional medicine efforts have not been able to fully answer the health problems they face today, one of which is cardiac events. 
 Purpose: This study aims to analyze the factors that influence the pattern of health-seeking behavior of the Outer Baduy community against heart disease
 Method: This study is an analytical observational study with a cross-sectional approach to the Outer Baduy community that was diagnosed or suspected of having cardiac problems in 2023. Data was taken using the questionnaire sheets containing data on respondents' characteristics, and their first experience of having heart attack symptoms. The outcome was their health-seeking behavior when facing the circumstances categorized into traditional and modern behavior. The data was analyzed using the Fisher Exact Test to find out the relationship between variables
 Results: Thirty-six respondents are involved in this study. Most respondents were male (25/69.4%) and were in the age range from 48 to 76 years old, had an educational background graduated from elementary school (16/44.4%), worked as traders (18/50.0%), had insurance (26/72.2%) and experiencing symptoms of typical heart disease (30/83.3). Most of the respondents seek modern medicine when experiencing a typical heart attack. There is a p-value of more than 0.05 between age, sex, education level, and occupation with health-seeking behavior. Insurance ownership and respondents' experience of feeling heart attack symptoms to health-seeking behavior p values of 0.000 and 0.002 (< α 0.05) respectively.
 Conclusion: Most respondents seek modern medical help when experiencing typical heart disease. There is no significant relationship between age, sex, education level, and occupation with health-seeking behavior in heart disease. Insurance ownership and experiencing typical symptoms of heart disease significantly affect the health-seeking behavior of the Outer Baduy community. The results of this study can be a consideration for local health policyholders in creating cardiovascular emergency health education programs for the community. The combination of modern curative medicine and traditional preventive medicine can be one approach in the health sector that can be done by the government to reduce morbidity and mortality due to cardiovascular events in the Baduy community. Further studies are needed to explore the Outer Baduy community's knowledge and perception of cardiovascular events and the barriers they face to getting the necessary medication.

Families adapting to COVID-19 in urban Bangladesh: "It felt like the sky fell apart and we were in shock".

The COVID-19 epidemic has especially impacted the urban population in Bangladesh. Studies on COVID-19 have primarily focused on the patient's perspective. It is important to understand the experience of family members who adopt caregiving roles, as the experience of COVID-19 also impacts, and is impacted by, household members. This study aimed to explore the challenges, preventative practices, health-seeking behaviour, and perspectives of navigating the health care system from the perspective of family members of persons who had recovered from COVID-19 during its initial outbreak in Bangladesh. Participants of this qualitative study were family members (n = 7) of persons who had recovered from COVID-19 (either suspected or confirmed). Semi-structured in-depth interviews were conducted over telephone. Thematic analysis was used to analyse the data. Analysis revealed three key themes: changes in everyday practices and choice of health care, challenges and constraints, and unexpected positive outcomes. All the themes had temporal dimension to them with four distinct phases: early stage of COVID-19, strict lockdown phase, COVID-19 diagnosis and illness period and post COVID-19 recovery. The importance of maintaining social contact for psychological wellbeing during critical times was evident in the study. Online communication and social media enabled participants to remain 'socially connected' which further supported their mental health. Increased attention to hygiene practices both before, during and subsequent to COVID-19 infections within families was reported. Physical distancing in case of a suspected or confirmed COVID-19 case was found logistically and socially impractical in a densely populated city.

Is low-dose computed tomography for lung cancer screening conveniently accessible in China? A spatial analysis based on cross-sectional survey

BackgroundRegular Low-Dose Computed Tomography (LDCT) for lung cancer high-risk population has been proved to improve health outcomes and relieve disease burden efficiently for both individual and society. With geographical impedance becoming the major barrier preventing patients from getting timely healthcare service, this study incorporated health seeking behavior in estimating spatial accessibility of relative scarce LDCT resource in China, thus to provide real-world evidence for future government investment and policy making.MethodsTaking Sichuan Province in southwest China as the study area, a cross-sectional survey was first carried out to collect actual practice and preferences for seeking LDCT services. Using Computed Tomography (CT) registration data reported by owner institutions representing LDCT services capacity, and grided town-level high-risk population as demand, the Nearest Neighbor Method was then utilized to calculate spatial accessibility of LDCT services.ResultsA total of 2,529 valid questionnaires were collected, with only 34.72% of the high-risk populations (746 individuals) followed the recommended annual screening. Participants preferred to travel to municipal-level and above institutions within 60 min for LDCT services. Currently, every thousand high-risk populations own 0.0845 CT scanners in Sichuan Province, with 96.95% able to access LDCT within 60 min and over half within 15 min. Urban areas generally showed better accessibility than rural areas, and the more developed eastern regions were better than the western regions with ethnic minority clusters.ConclusionsSpatial access to LDCT services is generally convenient in Sichuan Province, but disparity exists between different regions and population groups. Improving LDCT capacity in county-level hospitals as well as promoting health education and policy guidance to the public can optimize efficiency of existing CT resources. Implementing mobile CT services and improving rural public transportation may alleviate emerging disparities in accessing early lung cancer detection.

Awareness of urinary incontinence in pregnant women as a neglected issue: a cross-sectional study.

Pregnancy and labor are independent risk factors for the development of urinary incontinence (UI). Although UI is common during pregnancy, it is a health problem mostly neglected by pregnant women. The high prevalence of UI in pregnancy and its effects on the postpartum period justifies the need to determine the knowledge and attitudes of pregnant women regarding the prevention and management of UI. It is necessary to increase the awareness of pregnant women about UI, educate, consultant, and integrate pelvic floor muscle training into prenatal care services. This study aims to determine the UI awareness of pregnant women and their knowledge and attitudes in this context. This cross-sectional study was conducted with 255 pregnant women in a university hospital in Turkey between March and September 2020. Data were collected using the Incontinence Knowledge Questionnaire (PIKQ) and Urinary Incontinence Attitude Scale (UIAS). The UI prevalence was 51% during pregnancy. The mean score of PIKQ was 8.07±2.64, and only 6.3% of participants correctly answered all the questions regarding UI. The mean score of UIAS was 42.33±3.48. A positive correlation was found between UI knowledge and attitude score (r=0.35, p=0.00). The results showed that although UI is prevalent during pregnancy, pregnant women's knowledge of UI is poor. Nearly half of pregnant women need information. They tend to display positive attitudes towards UI, but not sufficient to improve their health-seeking behavior. Strategies should be developed to increase pregnant women's awareness of UI and to encourage them health-seeking behaviors for the prevention/management of UI during prenatal visits.

A prospective study on health seeking behaviour and post exposure prophylaxis received by animal bite victims at the anti-rabies clinic in a tertiary care centre of urban Bangalore.

Rabies is 100% preventable by administering early and complete post exposure prophylaxis (PEP). Animal bite victims must have the knowledge and attitude necessary to seek appropriate medical care at the earliest to receive the required PEP. The present study sought to ascertain the health-seeking behavior of animal bite victims, their knowledge and attitude regarding rabies prophylaxis, the PEP they received, and their level of compliance with the full course of anti-rabies vaccination. The study included animal bite cases that presented to the anti-rabies clinic and matched the eligibility criteria. All the required details were recorded using an internally validated structured questionnaire. All participants were followed up for six months to ensure their health conditions and compliance with the vaccination schedule. Out of 1058 respondents, 57.9% were adults, with 46.6% belonging to middle socioeconomic class. 91.1% of them were informed biting animals as dogs. Before arriving at the anti-rabies clinic, 93.3% of the study subjects washed their wounds, and 62.4% visited to another health facility. Rabies knowledge was inadequate among the study participants, only 54.8% being mindful about the disease and its prevention. The compliance with the full course of antirabies vaccination was found to be 77.9%. All subjects were healthy, confirming that PEP is safe and effective. Regular social and behavioral change communication (SBCC) needs to be implemented with regard to health-seeking behavior.

Communication in Healthcare Discourse: A Cultural and Linguistic Exploration of Exchanges between Healthcare Practitioners and Patients among Jukuns of Nigeria

This paper explored the cultural and linguistic aspects of health exchanges between healthcare practitioners and patients among the Jukuns of Wukari in Nigeria, within the health centres in the town. It focused on patient-healthcare-provider dynamics and found out how language and culture influenced healthcare communication within formal settings. Integrating ethnographic, sociolinguistic, and anthropological approaches, the study unveiled how language and culture impacted interactions and health-seeking behaviours in these centres. It revealed the roles of language and culture in understanding health information, healthcare provider-patient exchanges, and treatment adherence within the distinct sociolinguistic context of the Jukun. Using such qualitative techniques as interviews and observations in the health centres, the study captured the intricate verbal and nonverbal communication, specific cultural discourse patterns, and communication strategies used by patients and healthcare practitioners. Findings highlighted diverse cultural and linguistic methods employed by Jukuns, such as using proverbs, ironies, metaphors, and nonverbal cues, to express themselves in healthcare settings. The research showed that these methods could facilitate communication with familiar practitioners but might complicate interactions with those from different ethnic backgrounds. Ultimately, it offered crucial perspectives for refining healthcare provision, aligning with the precise linguistic and cultural contexts of the Jukun community within formal healthcare settings in Wukari and other parts of Jukunland. Based on the foregoing, the researchers recommended that health practitioners should make use of interpreters and familiarise themselves with the cultural and linguistic norms of their immediate communities for effective health discourse that would enhance quality healthcare delivery.

Perspectives of healthcare workers on integrated management of childhood illness in Pakistan: A phenomenological approach.

In 2019, an estimated 5.2 million deaths were reported among children less than 5years of age. At primary healthcare level, healthcare workers (HCWs) mostly rely on history and clinical findings and less on inadequate diagnostic facilities. To enhance case management skills of HCWs, World Health Organization devised an integrated management of childhood illnesses (IMCI) strategy in 1995, modified to distance learning IMCI in 2014. A qualitative phenomenological study was conducted to explore perceptions of HCWs about standard and distance IMCI. Four focus group discussions were conducted with purposively selected 26 HCWs (IMCI trained) from 26 basic health units of Abbottabad district in Pakistan. Gadamer's philosophical hermeneutics were adopted during the inductive thematic analysis. Five themes that emerged are inexorable health seeking behaviors, IMCI being a comprehensive algorithm for consultation, a tedious protocol, scaling up protocol to specialists and private practitioners, and administrative insufficiency by the department of health. Improvement in case management skills of HCWs was reported as a result of IMCI trainings. It needs administrative support, regulations to control poly-pharmacy and provision of drugs without prescription, and a curb on political and bureaucratic interference.

Mitigating the impact of COVID-19 on primary healthcare interventions for the reduction of under-5 mortality in Bangladesh: Lessons learned through implementation research.

The COVID-19 pandemic posed unprecedented challenges and threats to health systems, particularly affecting delivery of evidence-based interventions (EBIs) to reduce under-5 mortality (U5M) in resource-limited settings such as Bangladesh. We explored the level of disruption of these EBIs, strategies and contextual factors associated with preventing or mitigating service disruptions, and how previous efforts supported the work to maintain EBIs during the pandemic. We utilized a mixed methods implementation science approach, with data from: 1) desk review of available literature; 2) existing District Health Information System 2 (DHIS2) in Bangladesh; and 3) key informant interviews (KIIs), exploring evidence on changes in coverage, implementation strategies, and contextual factors influencing primary healthcare EBI coverage during March-December 2020. We used interrupted time series analysis (timeframe January 2019 to December 2020) using a Poisson regression model to estimate the impact of COVID-19 on DHIS2 indicators. We audio recorded, transcribed, and translated the qualitative data from KIIs. We used thematic analysis of coded interviews to identify emerging patterns and themes using the implementation research framework. Bangladesh had an initial drop in U5M-oriented EBIs during the early phase of the pandemic, which began recovering in June 2020. Barriers such as lockdown and movement restrictions, difficulties accessing medical care, and redirection of the health system's focus to the COVID-19 pandemic, resulted in reduced health-seeking behavior and service utilization. Strategies to prevent and respond to disruptions included data use for decision-making, use of digital platforms, and leveraging community-based healthcare delivery. Transferable lessons included collaboration and coordination of activities and community and civil society engagement, and investing in health system quality. Countries working to increase EBI implementation can learn from the barriers, strategies, and transferable lessons identified in this work in an effort to reduce and respond to health system disruptions in anticipation of future health system shocks.

Ocean salinity, early-life health, and adaptation

We study the effects of in utero exposure to climate change induced high ocean salinity levels on children's anthropometric outcomes. Leveraging six geo-referenced waves of the Bangladesh Demographic and Health Surveys merged with gridded data on ocean salinity, ocean chemistry and weather indicators (temperature, rainfall and humidity) from 1993 to 2018, we find that a one standard deviation increase in in utero salinity exposure leads to a 0.11 standard deviation decline in height-for-age. Effects on weight-for-height and weight-for-age for a similar magnitude increase in salinity are 0.13 and 0.15 standard deviations, respectively. Analyses of parental investments and health-seeking behaviors demonstrate that compensating actions along these dimensions to attenuate the detrimental effects of salinity are few and restricted to poorer households. Using satellite-sourced datasets on agriculture and land-use, we find that increasing salinity constrains farmers' land use choices, restricting cultivation in the more profitable seasons which leads to lower agricultural potential. In particular, the effects of salinity on child health originate in areas with lower agricultural intensity caused by the progressive salinization of productive lands. These results highlight the climate change related costs of environmental insults on early-life health outcomes in vulnerable populations.

Estimating the Prevalence of Self-Medication Practices among a Representative Population of Medical Students.

In the domain of healthcare delivery, self medication (SM) is a widely prevalent form of health seeking behavior. The current study has been planned with the objectives to estimate the prevalence of SM practices among medical students, and to assess the knowledge pertaining to SM among the study population. A cross sectional descriptive study will be conducted among a representative population of medical students in a rural medical college for a period of two months among 205 students. The data collection tool will be a pilot tested semi-structured questionnaire and will be used after obtaining written informed consent. The statistical analysis will be done using SPSS version 16. Results will be presented using descriptive (frequency, percentages, mean, and standard deviation) and inferential (chi-square test) statistics. Considering the rising and alarming trends of antimicrobial resistance, it is our duty that we estimate the prevalence of SM among medical students and accordingly create awareness about not encouraging indiscriminate use of over the counter drugs.

Assessment of the feasibility of a community-based mental health training programme for persons with disabilities by non-specialists from different stakeholders’ perspectives in Bangladesh

IntroductionBangladesh is a developing country where 11% of the population has at least one disability, but no community-level mental health service is available. There is limited evidence of the burden of mental health issues and health-seeking behaviour among this population. This study assessed the feasibility of a training intervention for persons with disabilities, where peer support providers provided community-based disability-inclusive mental health services.MethodsFour stakeholder groups participated in this qualitative study: peer responders (trained persons with disabilities), trainers, representatives of organisations of persons with disabilities and disability-specific organisations, and officials of international and national non-governmental organisations. Two types of qualitative interviews were used to collect data, and thematic analysis techniques were utilised.ResultStakeholders perceived the peer responder training programme as acceptable for persons with disabilities to develop themselves as peer support providers, with potential benefits including increased mental health literacy, ensuring accessible mental health services, and improving the well-being of persons with disabilities. Potential challenges included receiving training and delivering services. Increased training duration, more fieldwork, supervision opportunities, and refresher training were recommended to mitigate training challenges. Financial support and formal community recognition were deemed necessary for training delivery.ConclusionThe peer responder training programme was feasible to ensure accessible mental health services for persons with disabilities, build a workforce to screen for mental health conditions, and provide appropriate referrals. A multi-sectoral collaboration of government and non-governmental institutions is recommended to policy advocates to expand the peer responder training programme in the mainstream mental healthcare system.

Cultural factors and family influences on adolescent oral health: qualitative research in a socially disadvantaged population.

This qualitative study sought to assess the influence of cultural factors and family on oral health behaviour of 12- to 15-year-old adolescents from the socially disadvantaged population. A qualitative design was developed with focus group discussions (FGDs) among 12- to 15-year-old adolescents. Four focus groups (n = 32 participants) were created from a selected sample to capture oral health beliefs and practices, oral health-seeking behaviour along with other relevant information. Focus group discussions were audio-recorded, transcribed verbatim and translated. Data were analysed thematically and structural coding was applied. Three key themes that emerged from FGDs were importance of oral health; role of family in oral health behaviour; and beliefs influencing access, prevention and treatment of oral diseases. Cultural background, family values and beliefs were imperative in moulding the behaviour of adolescents towards oral health. The use of traditional oral hygiene aides was a norm in this population. Findings of the study provide greater insights into the authoritative role of family and cultural barriers in the uptake of dental services. The study also highlights the potential value of qualitative research and emphasizes the need to integrate oral health-associated cultural beliefs and attitudes of the adolescents towards a wider evidence base.

Factors affecting healthcare-seeking behaviour among men who have sex with men in Starehe sub-county, Nairobi City County

Men who have sex with men (MSM) are a marginalized population in Kenya. When seeking medical care, they usually encounter obstacles due to accusations and public discrimination. As a result, MSMs put themselves at risk of developing serious illnesses that would burden the economy. This study aims to identify the barriers and behaviors that influence MSM healthcare-seeking. A quantitative study was conducted in Nairobi's Starehe sub-county. The researcher randomly selected participants at a Support Widows and Orphan Programmers drop-in center. The investigation happened between December 13, 2021, to January 15, 2022. Participants were subjected to a self-administered questionnaire after consenting. Most respondents were youths (92.7%:190). MSM's who encountered discrimination while receiving treatment were three times more likely to be afraid to seek medical attention (UOR=3.2, 95% CI). The majority of MSMs preferred non-government institutions (56.1 %; 115). The MSMs who were denied medical care were more likely to be afraid to seek care (UOR=3.9, 95% CI (1.192, 12.434). MSMs showed confidence in disclosing their sexual orientation to a health provider (82.1%:133) compared to family members (18.3%:11). The study found that MSMs' have challenges and poor health-seeking behaviors that is due to lack of a strategy for providing medical care to MSMs. The Ministry of Health should plan on how to supply items like drugs and protective devices required in the treatment and prevention of diseases among MSMs. Participants in this study were selected at the centrally located site in Nairobi County. The selection at one center can contribute to sampling bias.

Health information sources and health-seeking behaviours of Filipinos living in medically underserved communities: Empirical quantitative research.

To describe sources of health information and health-seeking behaviours of adults (aged ≥18) living in medically underserved communities in the Philippines. This is a secondary, quantitative analysis from a cross-sectional parent study. Participants completed a 10-item, self-report survey on their sources of health information, healthcare providers sought for health and wellness and health-seeking behaviours when ill. Responses were evaluated across two age groups (<60 vs. ≥60 years) and genders using generalized linear mixed models. Surveys were completed by 1202 participants in rural settings (64.6% female, mean age 49.5 ± 17.6). Friends and/or family were their key source of health information (59.6%), followed by traditional media (37%) and healthcare professionals (12.2%). For health promotion, participants went to healthcare professionals (60.9%), informal healthcare providers (17.2%) or others (7.2%). When ill, they visited a healthcare professional 69.1% of the time, self-medicated (43.9%), prayed (39.5%) or sought treatment from a rural health clinic (31.5%). We also found differences in health-seeking behaviours based on age and gender. Our findings highlight the need to organize programs that explicitly deliver accurate health information and adequate care for wellness and illness. Study findings emphasize the importance of integrating family, friends, media and healthcare professionals, including public health nurses, to deliver evidence-based health information, health promotion and sufficient treatment to medically underserved Filipinos. New knowledge provides valuable information to healthcare providers, including public health nurses, in addressing health disparities among medically underserved Filipinos. This study addresses the current knowledge gap in a medically vulnerable population. Healthcare professionals are not the primary sources of health information. Approximately one-third of participants do not seek them for health promotion or treatment even when ill, exacerbating health inequities. More work is necessary to support initiatives in low- and middle-income countries such as the Philippines to reduce health disparities. We adhered to the reporting guidelines of STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) for cross-sectional studies. There was no patient or public contribution as our study design and methodology do not make this necessary.

National cross-sectional cluster survey of tuberculosis prevalence in Timor-Leste: a study protocol

IntroductionTimor-Leste has one of the world’s highest estimated tuberculosis (TB) incidences, yet the data which informs this estimate is limited and the true burden of TB disease is not known....