Access To Health Services Research Articles

Recommendations for improving accessibility of digital health interventions for cardiometabolic disease for ethnically diverse populations.

Digital health interventions (DHIs), such as apps, websites and wearables, are being presented as solutions or enablers to manage the burden of cardiometabolic disease in healthcare. However, the potential benefits of DHIs may not be reaching the most in-need populations, who may face intersecting barriers to accessing health services and digital solutions. The Digital Interventions for South Asians in Cardiometabolic Disease (DISC) study used a mixed-method approach to focus on people of a South Asian background, a high-risk group for cardiometabolic disease. A one-day workshop was held in May 2023 with key stakeholders, including people with lived experience, health professionals, technology innovators and policymakers (n = 34), to develop recommendations arising from the DISC study findings. Discussions covered four areas: actions to support individuals to access and benefit from DHIs; translating learning about inclusive design into practice; the role of regulation and evaluation to improve inclusivity of DHIs used within the health service; and improving quality of data collection and use to reduce inequalities related to digital health and cardiometabolic disease. Our recommendations align with recent national strategies and provide specific examples of actions that can be taken to address digital inequalities for ethnic minority populations.

Geographic accessibility to hospital childbirths in Brazil (2010-2011 and 2018-2019): a cross-sectional study.

Delays in obstetric care are associated with adverse maternal outcomes, while long-distance travel for delivery is associated with high neonatal mortality and increased maternal morbidity. Distance and travel time are key components of geographic accessibility to health services and important risk indicators for maternal and neonatal care. This study evaluated whether the Brazilian Unified Health System (SUS) has been geographically accessible in providing hospital childbirth services, over time. Geographic accessibility to hospital deliveries in Brazil was mapped over two biennia (2010-2011 and 2018-2019), spanning a 10-year period, using national aggregated data from SUS Hospital Admissions Authorizations. Travel flows, distances, and times between women's municipalities of residence and hospitals were estimated. A total of 6,930,944 hospital deliveries were analyzed. Overall, 25.4% (n=1,759,306) of pregnant women traveled outside their municipalities to give birth in SUS hospitals, increasing from 23.6% (n=843,501) in 2010-2011 to 27.3% (n=915,805) in 2018-2019. Distance and travel time rose by 31.1% (54.0km-70.8km) and 33.6% (63.1-84.3min), respectively. Women experiencing maternal and/or neonatal death traveled longer distances and times. Regional disparities were evident: the Northeast had the highest proportion of women traveling (35.6%; n=817,499), and the North had the lowest (16.0%; n=138,295). Women in the North faced the longest travel distances (97.5-133.4km) and times (1,012-1,850min), while those in the Southeast and South experienced the shortest distances (37.2-55.9km and 41.2-54.8km, respectively) and times (38-52min and 41-52min). The results highlight regional disparities in maternal health service access within the SUS, which may affect maternal and neonatal outcomes. Targeted public health measures are needed to improve the availability of service, particularly in the North and Northeast regions, where access issues are most severe. Fundação Oswaldo Cruz; CNPq; FAPERJ.

TELEMEDICINE AND MEDICAL MALPRACTICE

Digitization in healthcare covers many topics such as artificial intelligence, robotic surgery, wearable health technologies, nanotechnology, 3D printers, virtual reality applications, electronic prescription, and remote health delivery services (telemedicine). Among these developments, telemedicine is one of the applications that are expected to cause significant changes in the classical patient-physician relationship in the near future. Telemedicine is defined as the use of electronic information and communication technologies to provide and support health services in situations where distance is a problem. According to the World Health Organization (WHO), telemedicine applications are divided into five main categories: teleradiology, teledermatology, telepathology, telepsychiatry, and telemonitorization. Due to the increasing need and demand after the COVID-19 epidemic in Turkey, the "Regulation on the Delivery of Remote Health Services" was published in the Official Gazette dated 10.02.2022. Telemedicine applications, which are fast, effective and financially sustainable healthcare services, have various advantages and disadvantages. This system offers main advantages such as increasing the quality of health services, decreasing economic costs, providing equally accessible health services to everyone, including those living in different age groups and/or rural areas, alleviating the workload of the emergency service, and preventing the increasing incidence of violence in health. Besides lack of face-to-face communication, insurance payment coverage, and digital security problems are the possible disadvantages of the system. The lack of the necessary legal infrastructure and the new implementation of telemedicine pose significant risks in terms of malpractice. In addition to informed consent, diagnosis, follow-up, treatment, consultation, and medical record processes, in these cases, it is important for medical malpractice evaluation to reveal the differences between telemedicine from classical medical education teachings and to draw its legal framework clearly. In our study, it is planned to guide the possible processes in Turkey by considering the approaches to malpractice in the practices of countries where telemedicine is applied.

The availability and distribution of health services and resources across different regions in Afghanistan

BackgroundEnsuring equitable access to healthcare services is fundamental to a robust healthcare system, especially during humanitarian crises. This study analyzes the availability and distribution of health resources across Afghanistan, aiming to provide a data-driven understanding of healthcare resource access and identify potential disparities, a critical aspect of effective humanitarian response planning.MethodsPrincipal investigators collated related data and literature from databases and data warehouses in a systematic approach using search strings and collection tools to query databases and available data warehouses to assess the availability and distribution of health services and resources across different regions in Afghanistan, with the principal database queried being the Afghanistan Health Resources Availability database (HeRAMS), an electronic and web-based system conceived by the World Health Organization. An Excel version was sourced.ResultsThe sub-health center represents 31.1% of the health facilities, followed by the basic health center (22.5%) and the mobile health team (17.1%). More than 85% of these facilities are fully operational, with the highest percentage observed in the Southern and Northeastern regions at 96.8%, followed closely by the central highland and Southeastern regions. Outpatient services for primary care are notably prevalent in the Northeastern, Southeastern, Southern, Eastern, and Northern region, conversely, the Capital and Central Highland regions demonstrate the lowest provision of primary care services. Antenatal care services are accessible at a level exceeding 70% in nearly all regions, with the highest accessibility in the Northeastern region at 91.3%, the prevalence of non-communicable illness clinics was observed to be below 50%, with the highest availability in the Southern region at 49.4%, followed by the Southeastern region. In terms of sanitation facilities, availability surpasses 70% across Afghanistan, with the highest observed in the Northeastern region at 89.2%.ConclusionThe study highlights significant disparities in healthcare access across various regions, with notable challenges in the availability of critical services. Furthermore, the study underscores the significant impact of financial constraints and equipment shortages on the functionality of healthcare facilities, particularly in the Northeastern and Western regions. This analysis emphasises the need for targeted resource allocation and infrastructure improvements to address inequities in access to essential healthcare services, particularly for underserved populations, thereby facilitating the achievement of equitable health outcomes in Afghanistan.

Asylum seekers' and refugees' experiences of violence and accessing healthcare in the UK: a systematic review.

This systematic review aimed to characterize the violence, explore the experiences of accessing health services, and highlight any strategies used to improve the access and experiences of healthcare for asylum seekers and refugees in the UK. EMBASE, EMCARE, MEDLINE, CINAHL, and Web of Science were searched in February 2024. We included manuscripts that included asylum seekers or refugees who had accessed healthcare settings in the UK. The Joanna Briggs Institute tools were used to assess risk of bias, and data were synthesised narratively. Twelve manuscripts were included in this review published between 2004 and 2023. The violence experienced by asylum seekers and refugees was characterized as domestic violence, family violence, torture, and sexual violence. There are vulnerability and cultural issues, health issues, and health innovations that affect the experiences and access to healthcare by asylum seekers and refugees. Providing holistic antenatal and midwifery services, reducing language barriers, addressing specific health needs, and careful use of digital health innovations can improve the access and healthcare experiences of asylum seekers and refugees. These data provide public health and healthcare services some insight into how to provide culturally safe, accessible healthcare for asylum seekers and refugees in the UK.

N49 Sexual and reproductive health of Australian women who live with Inflammatory Bowel Disease

Abstract Background Robust research in the field of inflammatory bowel disease is readily available, however an exploration of gender issues which are specific for women who live with inflammatory bowel disease remain limited in the literature. Currently much of the literature regarding sexual health is limited to reproduction and sexual dysfunction and the broader impact that inflammatory bowel disease has on sexual wellbeing is not well understood. By exploring sexual and reproductive health issues for Australian women who live with inflammatory bowel disease, this research aims to draw attention to the current limitations within the literature and to stimulate discussion and inform future directions for research, policy, and practice. Methods An exploratory concurrent mixed methods study, using an online survey and qualitive interviews, was employed to develop an understanding of the sexual and reproductive health needs of Australian women who live with inflammatory bowel disease. The survey included questions specific to women’s physical and emotional health, their self-esteem, their satisfaction with life and women’s pregnancy related knowledge specific to inflammatory bowel disease. Additionally qualitative interviews allowed for further exploration of women’s experiences accessing health services and more detail regarding the challenges for them as women and the impact of inflammatory bowel disease on their identify. In keeping with feminist frameworks, qualitative data collection and analysis was informed by Anderson and Jack (1991) and Hesse-Biber (2014). This included the interviewer actively listening and encouraging women to talk about their day-to-day experiences and feelings which were related to their sexual and reproductive health and how this may have been impacted by their diagnosis of inflammatory bowel disease. Results Australian women participated in conversational interviews and completed an online survey. Preliminary themes which have emerged from this research include Sexuality, Sexual and reproductive health; Feeling vulnerable and dismissed. Conclusion Research which focuses specifically on the sexual health experience of women living with inflammatory bowel disease is important to inform acute and chronic models of care which are relevant across women’s lifespan. Findings may help to inform nursing curricula, primary healthcare service delivery and sexual and reproductive health services policy development. References Anderson, K., & Jack, D. (1991). Learning to listen: Interview techniques and analyses. In S. Berger-Gluck, & D. Patai (Eds.), Women’s words: The feminist practice of oral history (pp.11 – 26). Routledge Publications. Braun, V., & Clarke, V. (2016). Thematic Analysis. In E. Lyons & A. Coyle (Eds.), Analysing qualitative data in Psychology (2nd ed., pp.84 – 103). SAGE publications. Hesse- Biber, S. (2014). Feminist approaches to in-depth interviewing. In S. Hesse- Biber (Ed.), Feminist Research Practice (pp. 182 – 232). SAGE publications.

Displacement Stressors, Trauma Exposure, and Mental Health: A Survey of Asylum Seekers and Refugees.

The mental health of asylum seekers and refugees (ASRs) is a pressing global concern, with complex trauma histories and environmental stressors contributing to heightened vulnerability. This study investigates the mental health and service utilization patterns of ASRs in Hong Kong, where unique policy landscapes pose additional challenges to this population. A cross-sectional survey was conducted with 100 ASRs in Hong Kong. Participants completed measures assessing displacement-related stressors, trauma exposure, mental health symptoms (depression, anxiety, stress, PTSD/CPTSD), and mental health service utilization. Participants reported high levels of displacement-related stressors and trauma exposure. The majority exhibited symptoms of depression, anxiety, and stress, with a significant proportion screening positive for PTSD/CPTSD. Despite high mental health needs, their service utilization rates were low. Trauma exposure and displacement-related stressors were significantly associated with poorer mental health outcomes, but not with service utilization. ASRs in Hong Kong face significant mental health challenges, influenced by both pre- and post-migration factors. Findings underscore higher rates of mental distress in the present sample compared to prior studies in ASRs and other local surveys. While trauma-informed care is crucial, efforts to improve mental health service access and reduce systemic barriers are needed with targeted strategies and policy changes.

Assessing Health Service Accessibility for Community-Based Rehabilitation (CBR) Trainees in Malaysia: Implications for Inclusive Healthcare

ABSTRACT This study aims to examine the accessibility of Community-Based Rehabilitation trainees to public health services in Malaysia. Quantitative data were collected from 290 parents and guardians across 14 CBR locations using multi-stage simple random sampling. Accessibility to health services and facilities was measured in terms of service availability, suitability, convenience, and adequacy. A four-level Likert scale was employed to assess the condition of the health services and facilities. A questionnaire was employed, and data were analyzed using SPSS. Findings revealed high satisfaction with health campaigns (79.0%), preventive services (74.8%), healthy food programs (74.5%), medical treatment (73.8%), equipment/assistive services (74.1%), and rehabilitation/therapy (67.2%). Results demonstrated significant correlations between trainees’ self-change and satisfaction with health services. Improved accessibility to health services was shown to positively impact trainees’ ability to perform daily activities, highlighting the importance of tailored, accessible health programs in supporting the development and independence of individuals with disabilities.

Experiences with Oral Pre-Exposure Prophylaxis (PrEP) Service Delivery and Use Among Adolescent Girls and Young Women (AGYW) in Routine Primary Care Settings, South Africa.

In South Africa, oral PrEP was included in national guidelines as part of a combination HIV prevention package for adolescent girls and young women (AGYW) in 2017. Understanding their experiences of accessing and using PrEP is necessary to evaluate and improve PrEP service delivery approaches. This descriptive study explored AGYW's knowledge and understanding of PrEP, their experiences and influences on PrEP access and use in real world settings in South Africa. We conducted 44 in-depth interviews with female PrEP users (15-24 years) enrolled in Project PrEP. Interviews were audio recorded and transcribed for analysis using thematic analysis procedures. Participants reported positive experiences and overall satisfaction with accessing health services (i.e., youth-friendly clinic spaces, friendly and non-judgemental staff, privacy during consultations). Distance from the clinic, long queues, negative provider attitudes, and occasional stock-outs were key health service barriers to accessing PrEP. Individual motivating factors to continued PrEP use included creating daily pilltaking routines and the goal to remain HIV negative, while barriers included pill fatigue, frequent clinic visits, and side-effects. Positive relationships with partners and family facilitated disclosure of PrEP use, while stigma was identified as a community barrier to accessing PrEP services. Our study highlights AGYWs' experiences with PrEP access and use in a real-world setting. Facilitators and barriers identified in this study can be leveraged to strengthen efforts to support young women and ensure effective PrEP use. The findings also contribute to the development of appropriate service delivery.

The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study.

During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. COVID-19 had a significant impact on social relationships (β=-4.35, 95% CI 6.38 to -2.32; P<.001), cultural activities (β=-.55, 95% CI -0.75 to -0.35; P<.001), cognitive functioning (β=-1.00, 95% CI -1.28 to -0.72; P<.001), depressive symptoms (β=.42, 95% CI 0.10-0.74; P=.009), physical health (β=.07, 95% CI 0.04-0.10; P<.001), and ICT use (β=-.11, 95% CI -0.18 to -0.03; P=.008). Internet use predicts reduced depressive symptoms (β=-.56, 95% CI -1.07 to -0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities (β=-.73, 95% CI -1.22 to -0.24; P=.003) and cognitive functioning (β=1.36, 95% CI 0.67-2.05; P<.001). The pandemic had adverse effects on older adults' health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110.

The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK.

This study evaluated the impact of 2015/2016 prescribing guidance on antidepressant prescribing choices in children. A retrospective e-cohort study of whole population routine electronic healthcare records was conducted. Poisson regression was undertaken to explore trends over time for depression, antidepressant prescribing, indications and secondary care contacts. Time trend analysis was conducted to assess the impact of guidance. A total of 643 322 primary care patients in Wales UK, aged 6-17 years from 2010-2019 contributed 3 215 584 person-years of follow-up. Adjusted incidence of depression more than doubled (IRR for 2019 = 2.8 [2.5-3.2]) with similar trends seen for antidepressants. Fluoxetine was the most frequently prescribed first-line antidepressant. Citalopram comprised less than 5% of first prescriptions in younger children but 22.9% (95% CI 22.0-23.8; 95% CI 2533) in 16-17-year-olds. Approximately half of new antidepressant prescribing was associated with depression. Segmented regression analysis showed that prescriptions of 'all' antidepressants, Fluoxetine and Sertraline were increasing before the guidance. This upward trend flattened for both 'all' antidepressants and Fluoxetine and steepened for Sertraline. Citalopram prescribing was decreasing significantly pre guidance being issued with no significant change afterward. Targeted intervention is needed to address rising rates of depression in children. Practitioners are partially adhering to local and national guidance. The decision-making process behind prescribing choices is likely to be multi-factorial. Activities to support implementation of guidance should be adopted in relation to safety in prescribing of antidepressants in children including timely availability of talking therapies and specialist mental health services.

Barriers to treatment seeking for depression among elderly service users at Butabika National Referral and Teaching hospital, Kampala- Uganda

Objectives Depression among the elderly is a significant public health concern in Uganda, where cultural, social, and healthcare-related barriers hinder access to treatment and support. This study examines the barriers to mental health service access faced by elderly service-users in Uganda. Method Using an interpretive phenomenological approach, in-depth interviews were conducted to capture the lived experiences of elderly Baganda service users receiving treatment at Butabika National Referral and Teaching hospital. Results The findings reveal an intricate interaction between cultural, social, economic, and healthcare system-related barriers. Key barriers include limited mental health awareness, financial constraints, fragmentation, drug shortage and geographical access. Social and cultural stigma further exacerbate these challenges contributing to delayed or avoided help-seeking behaviours among the elderly. Conclusion The study highlights the intersectionality of aging and mental health issues, underscoring the urgent need for a comprehensive, integrated approach to mental health care for the elderly. This research calls for targeted interventions to reduce stigma, increase mental health literacy, and improve the accessibility and affordability of care for vulnerable elderly populations in Uganda. Such services can improve mental health outcomes and quality of life for the elderly in Uganda.

Factors influencing women's and men's place of birth decisions in rural Western Highlands Province of Papua New Guinea: A qualitative descriptive study.

Evidence shows that birthing with a skilled birth provider improves maternal and neonatal health outcomes. However, whilst most women in the Western Highlands Province of Papua New Guinea seek skilled health care during pregnancy in a health facility, more than half give birth at home or in the village without a skilled birth provider. To explore the factors influencing women's and men's decisions about place of birth in rural Western Highlands Province of Papua New Guinea. A qualitative-descriptive study was conducted. Semi-structured, in-depth interviews were conducted with 20 participants (16 women who were pregnant or recently given birth and four men whose partners were pregnant or recently gave birth). Interviews were audio-recorded and transcribed verbatim. The data was thematically analysed. Three key themes associated with the place of birth decision factors were identified from the study findings: (1) health service accessibility and availability, (2) socio-cultural influences, and (3) previous maternity care experiences. Participant experiences influenced their choice of place of birth, resulting in many giving birth at home in their village without a skilled birth provider. Maternal and child health services need to be appropriately tailored to improve accessibility and meet the unmet needs of pregnant women in Papua New Guinea. Additionally, health education programs should address socio-cultural factors influencing the uptake of healthcare services, especially in rural areas where health disparities are more evident. Further research is required to explore health worker perspectives, patriarchal control, and respectful care regarding health service utilisation in this study context.

Preferences for and acceptability of long-acting HIV prevention products among pregnant and lactating women accessing health services in Kenya: a mixed method cross-sectional analysis

BackgroundIncreased risk of HIV acquisition during pregnancy and lactation among women is evident, necessitating their inclusion in the evaluation of new HIV prevention interventions. Pregnant and postpartum women specifically face challenges with oral PrEP associated with stigma, and the burden of using other tablets. Long-acting products may address challenges related to oral PrEP, however, there is limited data on product-specific preferences and acceptability among pregnant and lactating women.MethodsWe conducted a mixed-method study to assess the preferences and acceptability of long-acting PrEP modalities either under development or already established among pregnant and lactating women. We conducted quantitative surveys (n = 434) and in-depth interviews (n = 80) in central and western Kenya. We used descriptive statistics and categorical variables to summarize frequencies and proportions. Inductive and deductive content analytic approaches were used for in-depth interviews.ResultsThe median age of respondents was 25 years (IQR 19.3–31.0). Majority were married (263/434, 61%), had completed high school (222/434, 51%), with no condoms use in the prior 3 months (348/434, 80%). The most preferred PrEP formulations were injectable (251/434, 57%) and implantable (175/434, 40%) options. Participants who preferred injectable PrEP had 8.56 times higher odds of considering ease of use as a reason. (aOR = 8.56, 95% CI [3.81–20.48]) and 3.71 odds of choosing perceived discreteness (aOR = 3.71, 95% CI (1.57–9.97)) as their preference reasons. Participants who preferred Implant for HIV prevention had 2.31 odds of considering it due to perceived effectiveness in preventing HIV as a preference reason (aOR = 2.31, 95% CI (1.21—4.66)) and 2.53-fold of considering discreteness as a preference reason (aOR = 2.53, 95% CI (1.46—4.59)). From the in-depth interviews, women reported prospective acceptability due to the perceived convenience of LA products, perceived effectiveness, reduced cost, improved privacy, and reduced stigma. Women had concerns regarding the safety and efficacy of the products during pregnancy and lactation.ConclusionAcceptability of LA products underscores the importance of considering the unique needs of pregnant and breastfeeding women in the development of future prevention interventions. Aligning preferences and needs would enhance the uptake and adherence outcomes of HIV prevention products.

Application of data mining for diagnosis of ENT diseases using the Naïve Bayes method with genetic algorithm feature selection

Ear, nose, and throat (ENT) disease is a disorder that occurs in the eustachian tube in one of the organs, be it the ear, nose, or throat. Early signs of ENT disease include sore throat, painful swallowing, swollen and red tonsils, runny nose, nosebleeds, blocked nose, discharge from the ears, and others. To determine the diagnosis, it is necessary to carry out a physical examination of the ears, nose, and throat as recommended by an expert, namely an ENT doctor. The research carried out was implementing data mining for the diagnosis of ENT diseases using the Naïve Bayes (NB) method. This method was chosen because it can increase the accuracy, efficiency, and accessibility of health services and is also easy to understand and apply to classify ENT disease symptom data. The NB method was used to build an ENT diagnosis classification model and the model performance was evaluated using accuracy, precision, and recall metrics. To increase the accuracy of the NB algorithm predictions, feature selection using a genetic algorithm can be used. Genetic algorithms can help select the most relevant and significant features, improving the accuracy of NB models by eliminating irrelevant or noisy features. By applying this method, predictions for ENT diseases can be produced with an accuracy of 95.67%.

Health Care Utilisation and Unmet Needs in Survivors ofHead and Neck Cancer in Regional Australia: A Cross-Sectional Survey.

The post-treatment survivorship period marks the transition away from acute care and poses distinct challenges for individuals with head and neck cancer (HNC). This can be especially challenging for people in regional areas who travel long distances to access care and experience unique challenges in accessing health services. To investigate unmet needs and healthcare utilisation of survivors of HNC in regional areas. Invitations were sent to 619 survivors of HNC living in rural New South Wales, Australia, who were 1-15years post-treatment. Participants self-reported unmet survivorship needs and the strength of these needs using the Cancer Survivors' Unmet Needs Measure. Health care utilisation over the preceding 12months was collected using an investigator-designed questionnaire. One hundred and seventeen responses were received (19% response rate). Participants were predominantly male (65%), had oropharynx cancer (52%), with mean age of 70.2years. Some 54% of participants reported at least one unmet need, and 40% rated these unmet needs as 'strong'. Top unmet needs included concern about recurrence (24%), access to local services (15%), and financial support (15%). 94% of participants reported seeing their GP, while 62% visited a dental clinic; only 10% sought professional psychosocial support despite prevalent unmet needs. Rural survivors of HNC in Australia have substantial unmet psychosocial needs yet demonstrate low utilisation of professional psychosocial support. This may reflect the limited availability or accessibility of services for this population, which could be addressed with shared models of care utilising both GP-led and telehealth services.

Model to explain dental visit for children aged 0 to 5: Scoping review of birth cohorts.

Health services accessibility is a multidimensional concept. An early-life dental visit could improve child dental health. Through birth cohorts, it is possible to identify health conditions and pathways of exposure that occur earlier in life. The aim of this study is to propose a theorical model to explain the use of dental care for children with primary teeth, based on results from birth cohorts. 3 databases were queried: PubMed, Embase and Dentistry & Oral Sciences Source. Eligible articles presented data on children's dental visits, with at least one follow-up visit between birth and the child's 6th birthday and based on birth cohorts. We identified 649 articles in biomedical literature databases. After exclusions, we read 136 abstracts, and finally 36 articles in their full length. A total of 22 articles were included in the analysis, from 15 countries on 5 continents. The mains proximal factors for access to dental care for preschool children are related to caregivers' perception of children's oral health and its impacts on quality of life. These perceptions are influenced by the child's oral health, the child's and mother's use of healthcare, and the healthcare organization. Dental fear seems to be another proximal factor. However, family social background seems to be an enabling moderator for dental visits. The scoping review allowed us to develop a model that explains dental visits for children aged 0-5 years as a multifactorial process influenced by caregivers' perceptions of the child's oral health, the family's quality of life, and the child's dental anxiety.

Classification of the Homeless as one of Asnaf Zakat: A Case Study of the Federal Territory of Kuala Lumpur

This study aims to analyze the categorization of the homeless and the factors contributing to homelessness. To achieve this objective, this study employs a research design based on a quantitative approach through interview surveys using questionnaires conducted on a group of homeless individuals in Kuala Lumpur. A total of 100 respondents were selected using purposive sampling techniques. The methodology employed for data analysis is the descriptive approach and binomial logistic regression. The findings indicate that homeless individuals should be categorized as asnaf fakir (poor) and miskin (needy), as their circumstances closely align with issues of poverty, followed by the categories of al-riqab (the slave or bondage) and ibnu sabil (wayfarer). Additionally, the study identifies economy factors, stigma and discrimination, as well as health and mental problems factors, as significant contributors to homelessness. Based on the research findings, this study recommends that all parties, including the government, zakat institutions, non-governmental organizations (NGOs), civil society, and others, collaborate in developing holistic and integrated solutions encompassing economic empowerment programs, accessible health and mental care services, a comprehensive assistance framework, rehabilitation programs, and anti-stigma campaigns to effectively support the asnaf group among the homeless.

Model Perilaku Pasien Pada Aplikasi Berbasis Kesehatan Menggunakan Metode Design Thinking

The COVID-19 pandemic has had a significant impact on health, economy, and society in Indonesia. In dealing with the pandemic, the term New Normal emerged, namely a change in behavior to continue normal activities by implementing health protocols. One of the innovations that has developed in this digital era is a health-based application designed to increase the accessibility of health services, such as online consultations, health monitoring, medication reminders, and health education. However, the success of this application depends not only on technology, but also on a deep understanding of patient behavior as users. Understanding patient needs, preferences, and challenges is important to create an optimal user experience. Without this, health applications are at risk of not being widely adopted. This study uses the Design Thinking method to understand patient behavior and design relevant solutions. With stages such as empathy, problem definition, ideation, prototyping, and testing, this study aims to design a patient behavior model in health-based applications. This approach is expected to provide a comprehensive picture of the factors that influence patient behavior, as well as help developers create applications that are more intuitive, effective, and in accordance with user needs in the era of the pandemic and new habits.

Knowledge, attitude, practices, and associated factors toward cervical cancer among female health sciences students of Addis Ababa University, Addis Ababa, Ethiopia.

Cervical cancer is the most common cancer in women worldwide. Early screening and vaccination can prevent cervical cancer; however, the low levels of knowledge, attitude, and practice among the young can contribute to the high prevalence of cervical cancer. This study aimed to assess the level of knowledge, attitude, and practice of cervical cancer and associated factors among female Health Sciences students of the College of Health Sciences at Addis Ababa University. A descriptive cross-sectional study was conducted from February 2022 to June 2022 among regular undergraduate female Health Sciences students of Addis Ababa University. Data was collected using a self-administered questionnaire and analyzed using SPSS. Results were presented using descriptive statistics and bivariate analysis was conducted to look at the existence of significant associations and determine adjusted odds ratio. Statistical significance was declared at p-value ⩽0.05. The majority of the study participants were within the age range of 18-24 years. From the 305 female Health Sciences students, almost all had heard about cervical cancer and 93.4% of them reported that human papillomavirus is the causative agent. About 75% of the respondents recognized at least one possible symptom of cervical cancer. Furthermore, nearly 70% and 78.3% of the participants showed positive attitudes toward taking and recommending human papillomavirus vaccines respectively. Only 16.1% and 48.9% of the respondents have good knowledge, and a positive attitude respectively. Surprisingly only 1.6% and 0.3% of the respondents have taken the human papillomavirus vaccine and undergone cervical screening respectively. Radiography technology students are about 86% less likely to have good knowledge compared to students in other fields of study (p = 0.04). Furthermore, year 4 and above students have significantly higher knowledge (89.2%) compared to those in years 1-3 (58%; AOR: 0.14, 95% CI: 0.05, 0.35). The knowledge of female Health Sciences students on cervical cancer was moderate, and about half had a positive attitude. However, their practice of human papillomavirus screening and vaccination was very low. Level of education and field of study were significantly associated with the knowledge of cervical cancer. Addressing gaps through awareness programs, and enhancing accessible health services can help empower these future health professionals.