Health Care Choices Research Articles

AN EDUCATIONAL INTERVENTION FOR UNDERGRADUATE STUDENTS TO PROMOTE AWARENESS OF END-OF-LIFE OPTIONS

Abstract Most people, of all ages, do not engage in advance care planning or know about available end-of-life (EOL) choices, despite the personal and societal benefits in an aging society, highlighting the need for educational intervention and outreach. We implemented an online educational intervention to explore accurate understanding of medical-aid-in-dying (MAID; available in ten states) among college students (n=415; Mage=19.6±4.4 years). Pre-intervention, 66% of participants had heard of MAID and 63% supported or strongly supported MAID. Participants were randomized to three conditions: control, testimonial narrative, or testimonial video explaining reasons why individuals pursued MAID (there were no significant differences in opinion by condition). Post-intervention, those in an intervention group were significantly more likely be more supportive of MAID legislation (p=.005); there were no significant differences between narrative or video conditions. Content analysis of open-ended responses revealed the importance of bodily autonomy and having a choice in health care. Participants who expressed neutral or conflicted perceptions wanted to learn more about the law and were concerned about individuals’ mental health when considering MAID. Negative responses reflected concerns about abusing the law and religious-based concerns. More accurate information about MAID and its safeguards is needed. In particular, the undecided group could benefit from selective interventions to improve understanding of MAID and other EOL care options. Future work should focus on education and outreach to individuals, families, and providers about aging and mortality issues to ensure more equitable access to quality EOL services and supports for people across the life span.

Lifetime influences on imaging markers of adverse brain health and vascular disease

Cerebral small vessel disease (cSVD) is highly prevalent in the general population, increases with age and vascular risk factor exposure, and is a common cause of stroke and dementia. There is great variation in cSVD burden experienced in older age, and maintaining brain health across the life course requires looking beyond an individual's current clinical status and traditional vascular risk factors. Of particular importance are social determinants of health which can be more important than healthcare or lifestyle choices in influencing later life health outcomes, including brain health. In this paper we discuss the social determinants of cerebrovascular disease, focusing on the impact of socioeconomic status on markers of cSVD. We outline the potential mechanisms behind these associations, including early life exposures, health behaviours and brain reserve and maintenance, and we highlight the importance of public health interventions to address the key determinants and risk factors for cSVD from early life stages.

The action logic of the older adults about health-seeking in South Rural China

BackgroundThe Chinese government has invested significant resources to build many rural healthcare stations. However, in the face of convenient medical paths and accessible medical resources, the utilization rate of health services for older adults in rural areas is surprisingly low. This study explored why health-seeking behavior among older adults in rural China was not active.MethodsData were collected through participatory rural appraisal (PRA) with 108 participants in 12 villages in southern China. Daily schedule and social and resource mapping were employed to outline the range of activities and the routine of the older adults, as well as in-depth interviews to understand the logic of their healthcare choices. Data collected were analyzed by content analysis.ResultsThree themes were generated: (1) perceptions of health status (being healthy or sick): the rural older adults used the ability to handle routine chores as a measure of health status; (2) prioritization of solving symptoms over curing diseases: the older adults preferred the informal self-medication to cope with diseases, as long as there were no symptoms and no pain; (3) ‘unpredictable’ troubles: they tended to favor the ‘optimal’ solution of keeping their lives in order rather than the best medical treatment options.ConclusionThis study showed that the medical practices of the rural elderly were profoundly influenced by their perceptions of health and their life experiences. In the face of diseases, they tended to keep their lives in order, preferring self-treatment practices that address symptoms or selectively following medical advice rather than medical and science-based clinical solutions. In the future, the construction of rural health care should focus on changing the ‘inaccessibility’ of healthcare resources at the subjective level of the rural elderly and develop culturally adaptable health education.

ENHANCING HEALTHCARE QUALITY AMONG COMMUNITY HEALTH FACILITIES WITH RESULTS-BASED FUNDING IN EASTERN UGANDA

This study examines the effects of Result-Based Funding (RBF) on the healthcare quality in Health Centre (HC) III in Jinja District concerning patient waiting time, drug stockout, choice of healthcare, and availability of essential medicines in Uganda's community health facilities. The research used a cross-sectional survey design and found that results-based funding like timely funding, and funding size had a significant relationship with healthcare quality. Management practices also had a strong positive correlation with healthcare quality, but most importantly management practices moderated the relationship between results-based funding and healthcare quality among Health Centre IIIs in Jinja District. The study recommends increasing the size of RBF, sending or providing timely funds, improving the fund size, and building and maintaining results-based incentives for staff that implement activities at the health facilities. Health Centre management to continue activity planning, improve staffing levels, carry out regular monitoring of all activities supported by the RBF programme, and ensure that storage capacity is enabled for the safety of essential medicines and other stores.

The Paradox of Choice in Healthcare: Treating Decision Paralysis

It is widely accepted that having more choices is inherently positive. When there are more available options from which to choose, an individual is more likely to be able to select the particular option that is the best fit and most likely to satisfy them. Hence, choice is typically thought to be related to personal freedom and enhanced well-being. Therefore, for most individuals the ultimate goal is to constantly maximize their choices in life to increase their overall satisfaction and well-being. The decision-making process, however, is a complex cognitive task that does not always lead to positive outcomes. In this article we discuss the decision-making process under the paradox of choice model. We shed light on the paradoxical relationship that increased choice has in the medical practice: instead of giving individuals the freedom to choose the best course of action to improve their overall satisfaction and well-being, overwhelming individuals with too much choice is actually found to be associated with decision paralysis, dissatisfaction, and diminished well-being. The purpose of this article is to draw attention to the consequences of choice overload in healthcare, and to help both practitioners and patients to avoid decision paralysis.

Influences on decision-making about disclosure of HIV status by adolescents and young adults living with HIV in KwaZulu-Natal, South Africa

Background: Adolescents and young adults living with HIV (AYA) are faced with the challenge of living with a life-long chronic condition. We investigated the influences on the decisions by AYA to disclose their HIV status to family, intimate partners and friends. Methods: Twenty AYA aged between 15 and 24 years were purposely selected through local community-based organisations in eThekwini municipality and uMkhanyakude district in KwaZulu-Natal Province, South Africa. Virtual in-depth interviews were conducted between September 2020 to October 2021 using a topic guide focusing on HIV-status disclosure and the impact of stigma on decision-making capacity. An iterative thematic process was used for analysis. Results: Findings revealed the challenges that AYA experience for disclosure because of stigma and how this impacts their decision-making capacity. Family and friends influenced AYA in processing their discovery of their HIV status offering support needed to manage living with HIV. However, for some AYA disclosing to relatives, friends and intimate partners was difficult because of fears of rejection and recrimination. The act of disclosure was influenced by both internalised and external stigma and the type of relationships and interactions that AYA had with relatives, friends and caregivers. Conclusions: The decision to disclose is challenging for AYA because of the fear of rejection, along with internal and external stigma. The provision of support, whether from family or peers, is important. Enhancing the decision-making capacity of AYA is essential for developing their self-esteem as well as supporting future healthcare choices.

Protecting the Body, Living the Good Life: Negotiating Health in Rural Lowland Laos

In rural lowland Laos, aspirations to a good life and visions of well-being are defined and impacted by the process of negotiating health. The state of sabai (well-being) situates the person in relation to their family, social, and spiritual worlds, and the associated practices have taken on increasing importance as new vulnerabilities and social struggles emerge in the late-socialist era. Traditional healers are rapidly disappearing while public biomedical health services have not yet fully evolved into a trusted alternative, leaving rural people in a healthcare gap involving complex care-seeking trajectories at high personal and familial cost. Differing experiences of the therapeutic encounter show how healthcare choices are closely associated with relationships. These experiences are influenced by the practitioner's motives for providing care, guided by the desire for a life that is both meaningful and judged as “good” according to social principles. Although lacking in financial compensation, providers who feel otherwise rewarded are likely to provide care that is acceptable to the patient and allied with the production of well-being. Village healers find satisfaction in personal and spiritual attainment and occupy a high social status where they experience reciprocity through care from others, while rural health staff lack agency and professional reward. Achieving a “good life” in rural Laos is thus highly interdependent with the good lives of others.

Building a national brand: The experience of The Ohio State University Wexner Medical Center Department of Surgery

People have an abundance of choices relative to health care choices. Patients can easily access personal reviews, third-party rankings, and other information from a computer or mobile phone. In turn, health care organizations can have difficulty setting themselves apart from others. A brand can refer to an organization’s image and design elements; the messaging and values it conveys to consumers, staff, and the public; and its reputation in the community. A strong brand evokes trust, reliability, and value among other competitors. The foundation of any health care organization’s brand is built on these key elements: mission, vision, and values; logo, colors, typography, and imagery; brand voice; brand consistency; brand experience. The Ohio State University Wexner Medical Center has positioned itself nationally as a leading academic health center. The Department of Surgery has built upon this strong brand to create an equally strong reputation among other departments nationwide. Marketing efforts for the department have focused on promoting its nationally ranked general surgery residency program, world-renowned clinical programs and faculty, and robust research portfolio. We herein highlight some of the tactics that go into building a strong, vibrant brand for a department of surgery.

Shared decision-making between paediatric haematologists, children with sickle cell disease and their parents: an exploratory study

Children with sickle cell disease (SCD) face various healthcare choices to be made during the disease process that may impact their lives. Shared decision-making (SDM) could improve their health outcomes. We assessed if, and to what extent, paediatricians engage children with SCD and/or their parents in the decision-making process. In this observational cross-sectional study, paediatric SCD patients and their parents visiting the outpatient paediatrics clinic of a university hospital participated in a SDM baseline measurement. Two evaluators independently and objectively analysed the level of patient involvement in decision-making from the audio-recordings of the consultations using the OPTION-5 instrument, a 0–20-point scale from which scores are usually expressed as a percentage of ideal SDM. The level of SDM, as perceived by patients, parents and paediatricians, was appreciated using the SDM-Q-9 and SDM-Q-Doc questionnaires, respectively. Scores could range from 0% (no SDM) to 100% (exemplary SDM). Twenty-four consultations in which a decision needed to be made about SCD treatment were audiotaped and analysed; six were from each paediatrician. The group consisted of 17 male and 7 female patients from various cultural backgrounds between 2 and 17 years old, with a mean age of 9.4 years (SD 4.2). Median OPTION-5 scores were 25.0% [IQR] 20.0–40.0%; range 0–55%). Median SDM-Q-9 and SDM-Q-Doc scores were 56.7% (IQR 39.4–88.9%) and 68.9% (IQR 57.8–77.8%), respectively.Conclusion: Although subjective scores of SDM were fair, the objectively scored level of SDM among children suffering from SCD leaves room for improvement. This may be realized by increasing knowledge about the benefits of SDM, child-centred SDM interventions and SDM-training for paediatricians that takes into account the complexity of intercultural challenges and risk communication between stakeholders.What is Known:• Children that suffer from sickle cell disease (SCD) are more vulnerable to factors that negatively impact the care that they receive as well as suboptimal health outcomes.• Shared decision-making (SDM) can help children participate in a collaborative decision-making process about their preferred treatment options and improve their health outcomes.What is New:• The level of participation in the decision-making process for patients suffering from SCD and the families that they belong to leaves room for improvement. The impact of intercultural challenges and the quality and consistency of risk-communication between stakeholders in paediatric SDM needs further exploration.• Paediatricians are more confident about their ability to involve the child and parents compared to how children and their parents experience their level of involvement in a shared decision-making process.

Evaluating the barriers to the utilization of complementary and alternative medicine (CAM) in the United States: An exploratory study

IntroductionThe utilization of certain forms of complementary and alternative medicine (CAM) is prevalent among adults in the United States. While researchers have extensively studied the factors influencing CAM use in Western countries, significant barriers to its adoption remain. This paper draws attention to the obstacles faced by individuals in their journey to using CAM. MethodsQualitative interviews were conducted with 21 patients who had turned to CAM for managing a chronic illness/condition. These in-depth, face-to-face interviews occurred in Miami, USA, during 2014–15. The sampling, data collection, and analysis processes of this study adhered to the principles outlined in Charmaz’s constructivist grounded theory approach. ResultsFrom the data, three central barriers to CAM utilization in the US emerged: 1) Financial barriers: A significant portion of CAM treatments is not covered by insurance, making them cost-prohibitive for many. 2) Skepticism and discouragement: Both conventional medical practitioners and a segment of the public exhibited a noticeable trend towards discouraging CAM use. 3) Evaluation challenges: Patients expressed difficulty in assessing the efficacy and benefits of various CAM treatments compared to their costs. DiscussionDespite the widespread interest in and use of CAM in the US, numerous barriers hinder its broader integration into mainstream healthcare. These obstacles not only restrict healthcare choices for the general public but also appear to favor a select demographic, potentially based on income and availability of information.

Landscape Analysis of Traditional Tribal Healers and Their Healing Practices in the Tribal-dominated States of India

Tribal communities have a rich history as some of the earliest inhabitants of the Indian subcontinent, living in harmony with nature for thousands of years. These indigenous or ethnic groups are spread throughout India, with significant concentrations in states like Chhattisgarh (30.5%), Jharkhand (26.0%), Odisha (22.8%), Madhya Pradesh (21.0%), Gujarat (14.7%), Rajasthan (13.4%), and Maharashtra (9.3%). In the peninsular region, notable tribal groups include Bhils, Santhals, Gonds, Ho, Kondh, Kols, Mundas, and Kharia, while in the northeast region, the prominent ones are Nagas, Mizos, Mikris, and Kukis. However, their access to healthcare is hindered by limited infrastructure, illiteracy, poverty, unemployment, socio-economic challenges, and marginalization. As a result, tribal communities often turn to traditional healers and indigenous medicinal practices, giving preference to traditional healing over modern healthcare options. Tribal traditional healers lack formal medical degrees, but their deep connection with indigenous communities makes them a preferred choice for healthcare. They are easily accessible to tribal populations and offer cost-effective services. These healers rely on their extensive traditional knowledge and skills, utilizing locally available medicinal plants, animal, and mineral substances, and incorporating specific ritual practices in their treatment methods for patients. Tribal healers are integral components of the available local healthcare system and play a critical role in delivering primary care services. The primary objective of this landscape analysis was to conduct a comprehensive examination of the socio-economic status, healing practices, and knowledge transfer methods of tribal healers and folk practitioners. Additionally, it aimed to create an evidence-based roadmap for their integration into the mainstream through upskilling, certificating, and federating the tribal healers. The study was ethnographic descriptive cross-sectional research conducted between May 15th and September 30th, 2023. The study comprised 1649 participants, encompassing Herbalists, Spiritual Healers, Diviners, Bone Setters, and Traditional Birth Attendants hailing from 43 districts in 7 tribal dominated states predominantly inhabited by tribal communities, namely Chhattisgarh, Jharkhand, Odisha, Madhya Pradesh, Maharashtra, Assam, and Arunachal Pradesh. Data collection occurred across 43 districts situated within the aforementioned states. The selection of tribal healers was done using an Exponential non-discriminative snowball non-probability sampling approach. The research methodology encompassed ethnographic research, interviews with healers, and documentary analysis. The analysis showcased the diversity of traditional healers, representing about 240 tribes, and emphasized the rich cultural and regional variations in their healing practices. The study involved tribal healers with an average age of 52.6 years, of which 82.4% were above 40 years old. These healers had varied roles and expertise, such as general herbalists, bone setters, Ojhas, or Dondai, each employing distinct diagnostic methods and treatments for the indigenous population. About 53.9% of folk healers were skilled in indigenous medicine, using natural substances for healthcare. Additionally, 42.5% of religious practitioners integrated social, cultural, and religious beliefs into their treatments, including rituals and sacrifices. Knowledge transmission followed the traditional guru-shishya tradition, where tribal healers learned from experienced healers orally, without written texts. Certification was valued as a way to gain public trust, and NGOs and federations played pivotal roles in advocating for traditional healing practices. Successful integration into mainstream healthcare required collaboration, coordination, and mutual respect between traditional and modern healthcare providers. Despite deep-rooted connections with their own communities, traditional healers face several common challenges in their practice such as Stigmatization and lack of recognition, Limited resources and infrastructure, Lack of formal training and certification, Legal and regulatory challenges, Ethical and legal dilemmas, and economic challenges. In conclusion, the landscape analysis shed light on the diverse healing traditions within tribal communities, emphasizing the importance of preserving and respecting these practices to safeguard cultural heritage and wisdom. Integrating traditional healing into comprehensive healthcare systems can enhance inclusivity and provide holistic care for tribal populations.

Private pharmacies as healthcare providers in Odisha, India: analysis and implications for universal health coverage

IntroductionIn India, as in many low-income and middle-income countries, the private sector provides a large share of health care. Pharmacies represent a major share of private care, yet there are...

Relationships between education and non-alcoholic fatty liver disease

IntroductionIndividuals with lower levels of education are at a higher risk of developing various health conditions due to limited access to healthcare and unhealthy lifestyle choices. However, the association between non-alcoholic fatty liver disease (NAFLD) and educational level remains unclear. Therefore, the aim of this study was to investigate whether there is an independent relationship between NAFLD and educational level as a surrogate marker for socioeconomic status (SES). MethodsThis cross-sectional study included 8,727 participants from the Paracelsus 10,000 study. The association between NAFLD and educational level was assessed using multivariable logistic regression models and multivariable linear regression. The primary endpoints were NAFLD (FLI score > 60) and liver fibrosis (FIB-4 score > 1.29). Further subgroup analysis with liver stiffness measurement was done. ResultsIn the study, NAFLD prevalence was 23% among participants with high education, 33% among intermediate, and 40% among those with low education (p<0.01). Importantly, a significantly reduced risk of NAFLD was observed in individuals with higher education, as indicated by an adjusted relative risk of 0.52 (p < 0.01). Furthermore, higher education level was associated with significantly lower odds of NAFLD and fibrosis. Additionally, a subgroup analysis revealed that higher liver stiffness measurements were independently associated with lower levels of education. ConclusionThe study's findings indicate that a lower education level increases the risk of NAFLD independent of confounding factors. Therefore, these findings highlight the potential impact of educational attainment on NAFLD risk and emphasize the need for targeted interventions in vulnerable populations.

United States rural residence is associated with increased acute maternal end-organ injury or mortality after birth: a retrospective multi-state analysis, 2007–2018

BackgroundGeographic-based healthcare determinants and choice of anesthesia have been shown to be associated with maternal morbidity and mortality. We explored whether differences in maternal outcomes based on maternal residence, and anesthesia type for cesarean and vaginal birth, exist. MethodsThis study was a retrospective multi-state analysis; patient residence was the predictor variable of interest and a composite binary measure of maternal end-organ injury or inpatient mortality was the primary outcome. Our secondary outcomes included a binary measure of anesthesia type for cesarean birth (general vs. neuraxial [NA]) and NA analgesia for vaginal birth (no NA vs. NA). Our predictor variable of interest was patient residency (reference category central metropolitan areas of >1 million population), fringe large metropolitan county, medium metropolitan, small metropolitan, micropolitan, and non-metropolitan or micropolitan county. ResultsWomen residing in micropolitan (OR 1.17; 95% CI 1.09 to 1.27) and non-metropolitan or micropolitan counties (OR 1.14; 95% CI 1.04 to 1.24) had the highest adjusted increased odds of adverse maternal outcomes. Those residing in suburban, medium, and small metropolitan areas underwent general anesthesia less often during cesarean births than those residing in urban areas. Patients residing in micropolitan rural (OR 2.07; 95% CI 2.02 to 2.12) and non-metropolitan or micropolitan (2.25; 95% CI 2.16 to 2.34) counties underwent vaginal births without NA analgesia more than twice as often as those residing in urban areas. ConclusionsRural-urban disparities in maternal end-organ damage and mortality exist and anesthesia choice may play an important role in these disparate outcomes.

Smartphone-Based Video Antenatal Preterm Birth Education

Preterm birth is a leading cause of infant mortality and child morbidity. Preterm birth is not always unexpected, yet standard prenatal care does not offer anticipatory education to parents at risk of delivering preterm, which leaves parents unprepared to make health care choices during the pregnancy that can improve survival and decrease morbidity in case of preterm birth. To evaluate the effect of the Preemie Prep for Parents (P3) program on maternal knowledge of preterm birth, preparation for decision-making, and anxiety. Recruitment for this randomized clinical trial conducted at a US academic medical center took place from February 3, 2020, to April 12, 2021. A total of 120 pregnant persons with a risk factor for preterm birth were enrolled between 16 and 21 weeks' gestational age and followed up through pregnancy completion. Starting at 18 weeks' gestational age, P3 program participants received links delivered via text message to 51 gestational age-specific short animated videos. Control participants received links to patient education webpages from the American College of Obstetricians and Gynecologists. At 25 weeks' gestation, scores on the Parent Prematurity Knowledge Questionnaire (scored as percent correct), Preparation for Decision Making Scale (scored 0-100), and Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety computerized adaptive test. Analysis was based on an intention to treat. A total of 120 pregnant participants (mean [SD] age, 32.5 [4.9] years) were included in the study; 60 participants were randomized to each group. Participants in the P3 group scored higher than those in the control group on knowledge of long-term outcomes at 25 weeks (88.5% vs 73.2%; estimated difference, 15.3 percentage points; 95% CI, 8.3-22.5 percentage points; P < .001). Participants in the P3 group reported being significantly more prepared than did participants in the control group for neonatal resuscitation decision-making at 25 weeks (Preparation for Decision Making Scale score, 76.0 vs 52.3; difference, 23.7; 95% CI, 14.1-33.2). There was no difference between the P3 group and the control group in anxiety at 25 weeks (mean [SE] PROMIS Anxiety scores, 53.8 [1.1] vs 54.0 [1.1]; difference, -0.1; 95% CI, -3.2 to 2.9). In this randomized clinical trial, pregnant persons randomly assigned to the P3 program had more knowledge of core competencies and were more prepared to make decisions that affect maternal and infant health, without experiencing worse anxiety. Mobile antenatal preterm birth education may provide a unique benefit to parents with preterm birth risk factors. ClinicalTrials.gov Identifier: NCT04093492.

Medical pluralism, healthcare utilization and patient wellbeing: The case of Akan cancer patients in Ghana

ABSTRACT Purpose As cancers increase in Ghana and in many low-and middle-income countries, healthcare utilization has become critical for disease management and patients’ wellbeing. There is evidence that medical pluralism is common among cancer patients in Ghana and many other African countries, which results in lack of adherence to and absconding from hospital treatments. The objective of this study was to examine ways in which beliefs in disease causation influence medical pluralism among Akan cancer patients in Ghana. Methods A qualitative research approach was employed in this study. In-depth interviews were conducted for thirty (30) cancer patients who were purposively recruited from Komfo Anokye Teaching Hospital in Ghana. Thematic content analysis was used in analysing data. Results Our findings revealed that cancer patients ascribed both physical and spiritual causality to their illness. As such, they combined orthodox treatment with spiritual healing and herbal medicine. Regarding the order of therapeutic search, patients reported to herbal and spiritual centres before going to the hospital, a phenomenon which contributes to the late reporting and diagnosis as well as bad prognosis of cancers in Ghana. Conclusion The findings of this research elucidate the relationship between culture and health care choices of cancer patients in Ghana. Increased awareness creation is crucial in eradicating myths surrounding cancers in Ghana.

Withdrawal of mechanical ventilation in amyotrophic lateral sclerosis patients: a multicenter Italian survey

BackgroundLaw 219/2017 was approved in Italy in December 2017, after a years-long debate on the autonomy of healthcare choices. This Law, for the first time in Italian legislation, guarantees the patient’s right to request for withdrawal of life-sustaining treatments, including mechanical ventilation (MV).ObjectiveTo investigate the current status of MV withdrawal in amyotrophic lateral sclerosis (ALS) patients in Italy and to assess the impact of Law 219/2017 on this practice.MethodsWe conducted a Web-based survey, addressed to Italian neurologists with expertise in ALS care, and members of the Motor Neuron Disease Study Group of the Italian Society of Neurology.ResultsOut of 40 ALS Italian centers, 34 (85.0%) responded to the survey. Law 219/2017 was followed by an increasing trend in MV withdrawals, and a significant increase of neurologists involved in this procedure (p 0.004). However, variations across Italian ALS centers were observed, regarding the inconsistent involvement of community health services and palliative care (PC) services, and the intervention and composition of the multidisciplinary team.ConclusionsLaw 219/2017 has had a positive impact on the practice of MV withdrawal in ALS patients in Italy. The recent growing public attention on end-of-life care choices, along with the cultural and social changes in Italy, requires further regulatory frameworks that strengthen tools for self-determination, increased investment of resources in community and PC health services, and practical recommendations and guidelines for health workers involved.

Addressing Intersectionality through Medical Pluralism

As the world experiences rapid industrialization and we stray away from deeper aspects of being, there is an alarming increase in problems related to mental health. A paucity of mental health professionals burdens health-care systems worldwide, and this problem has become more evident postpandemic. Such a situation indicates a gap that indigenous healing systems can bridge. This article aims to recognize the role of indigenous healing systems in mental health promotion. We also focus on how alternative medicine addresses cultural differences in mental health. After a brief comparison between conventional and alternative medicine, we explore possibilities for collaboration between the two. Findings suggest that individuals in emerging and low-income countries widely resorted to alternative medicine. It has a comprehensive set of benefits but also has its limitations as it is a loosely regulated field. Alternative practices remain a popular healthcare choice in emerging countries, and combining them with conventional medicine opens up new possibilities for holistic healing and decolonizing narratives in mental health.

First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization.

Costs associated with low back pain (LBP) continue to rise. Despite numerous clinical practice guidelines, the evaluation and treatments for LBP are variable and depend largely on the individual provider. As yet, little attention has been given to the first choice of provider. Early research indicates that the choice of first provider and the timing of interventions for LBP appear to influence utilization. This study sought to examine the association between the first provider seen and utilization. Using 2015-2018 data from a large insurer, this retrospective analysis focused on patients (29,806) seeking care for a new episode of LBP. The study identified the first provider chosen and examined the following year of medical utilization. Cox proportional hazards models were calculated using inverse probability weighting on propensity scores to evaluate the time to event and the relationship to the first choice of provider. The primary outcome was the timing and utilization of health care resources. Total health care utilization was lowest in those who first sought care with chiropractic care or physical therapy. Highest health care utilization was seen in those patients who chose the emergency department. Overall, there appears to be an association between the first choice of provider and future health care utilization. Chiropractic care and physical therapy provide nonpharmacologic and nonsurgical, guideline-based interventions. Their participation appears related to a decrease in immediate and long-term utilization of health care resources. This study expands the existing body of literature and provides a compelling case for the influence of the first provider on an acute episode of LBP. The first provider seen for an acute episode of LBP influences immediate treatment decisions, the trajectory of a specific patient episode, and future health care choices in the management of LBP.

Lost in Translation: Impact of Language Barriers and Facilitators on the Health Care of Asian Americans Living with HIV

Language barriers are major obstacles that Asian American immigrants face when accessing health care in the USA. This study was conducted to explore the impact of language barriers and facilitators on the health care of Asian Americans. Qualitative, in-depth interviews and quantitative surveys were conducted with 69 Asian Americans (Chinese, Filipino, Japanese, Malaysian, Indonesian, Vietnamese, and mixed Asian backgrounds) living with HIV (AALWH) in three urban areas (New York, San Francisco, and Los Angeles) in 2013 and from 2017 to 2020. The quantitative data indicate that language ability is negatively associated with stigma. Major themes emerged related to communication, including the impact of language barriers on HIV care and the positive impact of language facilitators—family members/friends, case managers, or interpreters—who can communicate with healthcare providers in the AALWH’s native language. Language barriers negatively impact access to HIV-related services and thus result in decreased adherence to antiretroviral therapy, increased unmet healthcare needs, and increased HIV-related stigma. Language facilitators enhanced the connection between AALWH and the healthcare system by facilitating their engagement with health care providers. Language barriers experienced by AALWH not only impact their healthcare decisions and treatment choices but also increase levels of external stigma which may influence the process of acculturation to the host country. Language facilitators and barriers to health services for AALWH represent a target for future interventions in this population.