Role Of Health Care Providers Research Articles

Menopause in Sickle Cell Disease: Unchartered Territory

Menopause is a natural part of every women's life, but it may also be a time of change leading to biopsychosocial complications. Perimenopause is the time during which the body transitions to menopause, marking the end of the reproductive years. The Society for Women's Health Research Menopause Working Group cites that signs of progression toward menopause such as menstrual irregularity may be noted in the 40s, but some women may notice changes as early as their mid-30s. Perimenopause can last several years. Perimenopausal care plays an important role in the promotion of healthy aging and quality of life. For some, symptoms of menopause can have a detrimental impact on quality of life and pose serious risks to bone, cardiovascular and genitourinary health. There is a paucity of literature in menopause and sickle cell disease (SCD). A longitudinal study in Brazil of 15 women with SCD and a multi-center study of hydroxycarbamide exposure and ovarian reserve by Pecker et al have both indicated that women with SCD may have early menopause. Our exploratory study sought to determine menopause health-literacy and describe bothersome menopausal symptoms in women with SCD. A multi-faceted approach (one-on-one semi-structured interview, focus group, and registry analysis) was used for this single-institution exploratory study. Individuals were recruited during their routine clinic visit. Inclusion criteria included age >30 and ongoing menstruation OR prior menstruation. Exclusion criteria included pregnancy, breast-feeding, and history of stem-cell transplant. First, a mixed-methods survey was utilized. Next, a focus group was conducted to further elicit the views of patients about menopause and the role of healthcare providers in management of menopause for individuals with SCD. The focus group discussion was transcribed and then examined for recurring themes. The individual surveys and focus groups indicated a perceived exacerbation of SCD symptoms and complications as individuals became perimenopausal. To further assess this, data from the Sickle Cell Disease Implementation Consortium (SCDIC) registry from our site was analyzed to compare healthcare utilization between age-matched males and females. A total of 17 individuals were interviewed individually with a semi-structured questionnaire during their routine clinic visit. Individuals with HbSS on hydroxyurea underwent menopause at a median age of 50 years while those on no disease modifying treatment underwent menopause at a median age of 39 years. Many patients felt uninformed about menopause. Those who felt knowledgeable about the topic received their information from their own career in healthcare, friends, family, and the internet (Table 1). The focus group consisted of 5 female participants (3 perimenopausal and 2 post-menopausal) to elicit each individual's experiences around menopause and menopause specific care. Participants indicated worsening of SCD, hot flashes, and genitourinary complaints as their most bothersome issues with menopause. Participants reported having more frequent crises as they went through the menopause transition. Overall participants indicated that, after menopause, pain crises and hot flashes improved but genitourinary symptoms persisted. In addition, participants cited frustration over inability to address menopause related symptoms with their healthcare providers and even mentioned that providers were dismissive of their symptoms or attributed them to SCD without considering menopause transition. Further information was gathered and analyzed from the SCDIC registry; results showed that non-pregnant women have increased numbers of admissions as they enter age group of 30-40 years (Poisson regression eβ [95% CI]: 1.4 [1.3-1.7], P <0.001), while admissions for men decrease as they enter age group of 30-40 years (Poisson regression eβ [95% CI]: 0.49 [0.36-0.68], P <0.001). For the 30-40 age group, women are more likely to have admissions compared to men (Table 2). This finding could potentially be related to premature menopause contributing to increased admissions. While this study is limited due to the small size and exploratory nature, our preliminary work indicates that menopause is unchartered territory, and that many gaps exist in menopause health literacy and menopause related care delivery for women with SCD. Our findings highlight the need for further research on menopause in SCD.

Infantile tremor syndrome: a case report

Infantile tremor syndrome (ITS) is a rare but significant clinical condition characterized by a tetrad of pallor, developmental delay or regression, skin pigmentation abnormalities, and sparse brown scalp hair, often accompanied by involuntary tremors. ITS primarily affects children aged 5 months to 3 years, with a higher prevalence in males, especially in regions like the Indian subcontinent, Southeast Asia, and Africa. The exact cause of ITS remains uncertain, but a strong association with vitamin B12 deficiency has been observed in numerous studies. Malnutrition, including deficiencies of zinc, magnesium, iron, calcium, and hypoalbuminemia, is common among affected infants, who often come from lower socioeconomic backgrounds with vegetarian mothers lacking animal food in their diets. In this case report, an 8-month-old female child presented with progressive tremors, poor feeding, and developmental delay. The child had been exclusively breastfed by a vegetarian mother and lacked proper complementary feeding. Clinical examination revealed pallor, hypopigmented hair, hyperpigmented knuckles, and generalized hypotonia. Laboratory tests confirmed vitamin B12 deficiency, anemia and other nutritional deficiencies. Neuroimaging showed cerebral atrophy. Treatment involved addressing the nutritional deficiencies, primarily through vitamin B12 supplementation, iron, magnesium, calcium, and a protein-rich diet. Tremors were managed with propranolol and phenobarbitone. Within a month of treatment, the child exhibited significant improvement in tremors, developmental milestones, and overall well-being. This case emphasizes the importance of considering ITS in infants with specific clinical features and highlights the role of healthcare providers in educating parents about proper nutrition during pregnancy and infancy. Early diagnosis and management, including nutritional interventions and symptom control, can lead to substantial improvements in affected children's health and development. Further research is necessary to better understand the etiology and optimal management strategies for ITS.

Knowledge and Attitude of Inflammatory Bowel Disease Patients Toward Colorectal Cancer Risk, Its Management, and the Role of Healthcare Providers: A Cross-Sectional Study in the UK.

Inflammatory bowel disease (IBD) increases the risk for colorectal cancer (CRC). Limited literature exists on patients' knowledge of CRC risk and management. Attitude toward doctor-recommended management and the role of healthcare providers (HCPs) in CRC risk awareness remain unexplored. This study aimed to fill the gap in knowledge about CRC risk awareness and management in IBD patients in the UK. This cross-sectional internet-based study was conducted in April-July 2019. Adult (>18 years) IBD patients with a confirmed diagnosis for 2 years and adequate command of English language were invited from non-Natinal Health Services sources. A self-designed and piloted questionnaire with open- and closed-ended questions was used. Closed-ended data were analyzed using descriptive statistics and open-ended responses were analyzed using content analysis. Ninety-two participants (52.5% Crohn's disease and 67.5% females) responded. Around 88% knew that IBD increased CRC risk. Only 20.7% were aware of colonoscopy as the best screening tool; 88% were unaware of screening initiation time. Almost 90% would agree to a doctor's recommendation of colonoscopy. For dysplasia with 10% risk of CRC, 46.7% would not agree with colectomy. Some 48% reported to have never had a discussion about the risk of CRC in IBD with their HCPs, while 58% were not informed of the role of screening and surveillance in managing CRC risk. IBD patients were poorly aware of CRC risk management and had mixed willingness to comply with a doctor's recommendation. HCP's role in cancer knowledge dissemination was suboptimal and patients desired more information.

Addressing knowledge gaps: the key role of community health workers and healthcare providers in human papillomavirus prevention and vaccine uptake in a border community.

The Human Papillomavirus (HPV) is the most common sexually transmitted infection and nearly every person who is sexually active will get HPV at some point in their lifetime without having the HPV vaccine. Healthcare Providers (HCPs) and Community Health Workers (CHWs) play an essential role in promoting the HPV vaccine and providing education about HPV in communities. Three focus groups with CHWs (n = 17) and HCPs (n = 7) were conducted and led by trained facilitators. In addition to participating in the focus group, CHWs and HCPs completed a brief questionnaire. Focus groups were voice recorded and transcribed for qualitative analysis. Independent coders conducted content analysis to identify the salient themes of the focus groups. Several important findings emerged from this study highlighting the barriers to HPV knowledge, gaps in the self-perceived role of HPV cancer prevention, and opportunities to action. Financial, knowledge, patriarchy, behaviors, attitudes, and fears were identified as the perceived patient-related barriers to promoting HPV cancer prevention. Both CHWs and HCPs explained that their female patients are often discouraged by their husbands from seeking out sexual health-related healthcare. Finding suggest the need for community tailored education on HPV and "best practice" trainings for HPV prevention that is applicable to both CHWs and HCPs.

Clinical use of autologous cell-based therapies in an evolving regulatory landscape: A survey of patient experiences and perceptions

Background: Clinical treatments involving autologous cell-based therapies (ACBT) remain prevalent despite a lack of scientific backing and an evolving regulatory landscape aimed at assessing their safety and efficacy for clinical adoption. This study seeks to assess patients’ experiences and perceptions of clinical treatments involving ACBT and their knowledge and views of the regulatory context and associated governance issues. Methods: An anonymous online survey of 181 participants who have been treated or are in the process of being treated with ACBT. Recruitment was via social media platforms. Data was collected through Qualtrics and analyzed using SPSS 29 for the quantitative responses and NVivo 1.7.1 for the qualitative responses. Results: Several themes emerged from the data, including the prominent role of healthcare providers throughout the patient journey, informational practices during the clinical encounter, the high prevalence of pay-for-participation trials, patients’ gaps in regulatory knowledge, and patients’ priorities regarding clinical trials and regulation of ACBT. Conclusions: The study makes a novel contribution to the literature by providing the first analysis of patients’ experiences and perceptions of an emerging cell-based therapy within an evolving regulatory landscape. The findings serve as a valuable resource for developing policy, promoting scientific rigor, and ensuring ethical oversight of ACBT and other upcoming cell-based therapies.

Nursing Approach and Nursing Care Plan in Breastfeeding Mother

Breastfeeding is a natural phenomenon which is showing a global decline in the last few years. Young, new generation mothers are more inclined towards the use of artificial milk for their newborn rather than breastfeeding. Exclusive breastfeeding is not practiced in the Indian sub continent. In this study, we will report 3 incidents of failure of breastfeeding and the role of healthcare providers, especially nurses, in imparting knowledge and education to the young mothers.

Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon)

This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.

Understanding the healthcare provider role on post abortion contraception adoption in India using National Family Health Survey-5

BackgroundPost abortion contraceptive use is an important area in provisioning of services associated with child birth planning. This study examines the factors related to the type and timing of initiation of contraception adoption among women who had undergone induced abortion. Study also tries to identify the role of personnel who provided the abortion service on decision of family planning adoption using complementary log–log model in India.MethodologyThe study uses the secondary data from the fifth round of the National Family Health Survey conducted during 2019–21. For, the analysis, we have used five-year women’s reproductive calendar to extract information on contraceptive use, post last induced abortion among women. We used complementary log–log regression models, to estimate relative risk ratios and its 95% Confidence intervals (CI).ResultsAccording to NFHS-5, out of all the last pregnancies (2,55,549), about three percent resulted in abortion. Most of the abortion occurred in private facilities (55%), with the help of health professionals (71%). From the women’s reproductive calendar, it was found that around 40% of the women adopted modern methods of contraception, with maximum adopting spacing method (33%), and only handful adopted permanent method (7%). It was also found that the likelihood of early adoption of permanent method increased to two times when the abortion is done by health professional compared to others [95% CI (1.25–3.30)].ConclusionThis emphasises a need for quality counselling related to timing and types of family planning as an essential part of the family planning program ensuring client centric approach suited to their needs and contexts that helps in alleviating any apprehensions associated with adverse effects of modern contraceptive methods.

An international comparison of student nurse practitioner diagnostic reasoning skills.

Nurse practitioners (NPs) play a pivotal role in health care provision. Diagnostic reasoning is an important core skill of advanced practice. The purpose of this study was to compare diagnostic reasoning skills of NP students. It also identified the variability in clinical teaching components of a sample of international NP curricula. An international group of NP students completed an online survey using a validated diagnostic reasoning scale during the first year of their NP program. Program faculty surveyed provided data on core curricula. The NP students' (n = 152) mean diagnostic thinking inventory (DTI) score was 142, flexibility in thinking subscale score mean of 73 with a knowledge structure in memory of 69. The programs surveyed required bioscience courses. Most programs provided opportunities for students to practice diagnostic thinking using individual precepted clinical hours (range 500-950) and objective structured clinical examinations. The lower scores of this group of NP students were similar to other NP students and first-year medical residents. Higher mean scores in the DTI reflect expertise and are developed over time. Courses providing a foundation of biomedical knowledge were identified in each program, with opportunities for the NP students to practice diagnostic thinking using objective structured clinical examinations and clinical practice hours. The use of the diagnostic reasoning inventory is a useful tool for evaluating student NP's diagnostic reasoning during their NP program. Nurse practitioner programs should consider the provision of dedicated clinical hours, including supervised clinical practice experiences and objective structured clinical examinations to improve diagnostic reasoning.

Role of primary healthcare providers in supporting a gifted child.

'Giftedness' in children relates to high potential, whereas 'talent' relates to high achievement. The concept of giftedness can be perplexing for those involved in caring for and supporting a gifted child. This article provides a starting point for primary healthcare providers in supporting gifted children by outlining a range of issues that may impact on these children. Gifted children are a heterogeneous population; giftedness occurs on a continuum. Giftedness can also co-occur with disabilities. Evidence-informed strategies to provide support to gifted children need to be considered.

Evaluation of the implementation of a medical respite program for persons with lived experience of homelessness

ABSTRACT Medical respite programs (MRPs) constitute a potential strategy to improve the continuum of care for persons who have lived experiences of homeless (PWLEH). A MRP was developed in Alberta, Canada, through a partnership between the provincial health authority (Alberta Health Services) and the province’s largest homeless shelter (Calgary Drop-In Centre). We conducted a qualitative study of 25 stakeholders who held an operational, administrative and/or healthcare provider role in the MRP’s design and implementation to evaluate the barriers and facilitators to its implementation using Proctor’s implementation framework. While stakeholders had a common motivation of addressing health inequity, the program’s acceptability and fidelity were hampered by a lack of clear common objectives and expectations. Program adoption was difficult due to differences in organizational policies and priorities. Program staff and leadership were dedicated to the patient population, enhancing feasibility, but the limited training and experience of frontline providers specifically in addictions and mental health resulted in important needs not being met (affecting intervention appropriateness). The lack of integration with community resources, despite being intended as a program to transition patients from hospital to community, affected program penetration. Our findings are relevant for other jurisdictions and organizations aiming to develop and implement similar interventions.

Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants.

Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.

Protocol for the mixed methods, Managing young people (aged 16–25) with Attention deficit hyperactivity disorder in Primary care (MAP) study: mapping current practice and co-producing guidance to improve healthcare in an underserved population

IntroductionAttention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents, with an average worldwide prevalence of 5%. Up to 40% of young people continue to...

Digital Technologies in Health Services: Old and New Challenges

ICT developments have affected all service sectors for several decades. Special occurrences, such as the Covid-19 pandemic, have accelerated the use of technological innovations in various fields. Health services have recently been one of the areas where digitalization is expected to bring great economic and social benefits. In addition to the benefits, many difficulties and obstacles exist for all involved partners. Evidence of the benefits and challenges of digitalization in the health service is the focus of this paper. The main purpose is to present an analysis of the current situation in Albania and to highlight the opportunities for further development, especially through the education of all parties and at all levels. The discussion is focused on the role of healthcare providers and beneficiaries in the successful use of telemedicine in Albania. It is closely linked to developments in other areas, such as education, digital infrastructure, data safety and protection, social policies, etc., making necessary all stakeholders’ engagement in this advancement process.

Role of Health Care Providers in Encouraging Formula Feeding in Mosul City.

Unacceptable advertisements and deceptive promotion of formula feeding undermine breastfeeding and threaten infant and maternal health worldwide. The purpose of this study was to estimate the role of healthcare providers and other sources in promoting the use of formula feeding among attendants at healthcare facilities in Mosul, Iraq. This one-year cross-sectional study was conducted at three healthcare facilities in Mosul, Iraq. Mothers of formula-fed infants under the age of one year were surveyed with a prepared questionnaire. Data analysis was performed using descriptive and inferential statistics. Of the 400 women who participated, 73% stated that healthcare professionals encouraged the use of formula feeding without a convenient reason, of which more than 80% were pediatricians and nursery nurses. Only 27% percent of the women chose to formula-feed their infants based on other factors. An extensive analysis of this attitude is warranted.

Real-world associations among patient-physician sex concordance, treatment practices, and cancer outcomes.

e18511 Background: Prior research has linked patient-physician sex discordance with inferior surgical and cardiac outcomes. The impact of such sex inequities may be magnified in medical oncology, where patients often face a life-limiting illness and physicians assume the role of primary healthcare provider. This study examined cancer treatment practices and survival outcomes in sex-concordant vs. discordant patient-physician dyads. Methods: This was a population-based, retrospective cohort study of adults diagnosed with stage II-IV colon or lung cancer in 2013-2020 in Alberta, Canada and referred to a medical oncologist. Study data included physician- and patient-level demographics and cancer disease characteristics. Patient-physician dyads were classified as sex-concordant (female-female, male-male) or discordant (female-male, male-female). Time-to-event data were analysed using Kaplan-Meier methods and associations were assessed with Cox and logistic regression. Results: A total of 11,131 patients and 188 medical oncologists were included. Among patients, 49% were female and 50% were in sex-concordant patient-physician dyads. The median age was 68 years, 7615 (68%) had lung cancer, and 6016 (54%) had stage IV disease. In sex-concordant and discordant dyads, respectively, median overall survival (OS) was 17.1 and 18.7 months ( p = 0.047) while median cancer-specific survival (CSS) was 20.2 and 22.4 months ( p = 0.21). In multivariable analysis, sex-concordance was not significantly associated with OS or CSS in the overall cohort and in female patients. However, among male patients, sex-discordance was significantly associated with lower OS (hazard ratio [HR], 1.11; 95% CI, 1.04-1.19) and CSS (HR, 1.12; 95% CI 1.04 -1.21), largely driven by differences in survival outcomes in stage IV disease. Older age, higher comorbidity burden, lung cancer, and advanced stage correlated with worse outcomes in all multivariable models. Sex concordance was not significantly associated with adjuvant systemic anti-cancer therapy (SACT) use in stage II-III disease or with SACT use in stage IV disease. Treatment practices are summarized in the table. Conclusions: Sex concordance between patients and medical oncologists did not generally correlate with differential SACT use and survival. However, male patients treated by female physicians had worse outcomes compared to those treated by male physicians. Cancer outcomes may be prone to the effects of sex bias in specific patient-physician relationships. [Table: see text]

HPV-Related Oral Lesions: YouTube Videos Suitability for Preventive Interventions including Mass-Reach Health Communication and Promotion of HPV Vaccination.

Given the need to improve patient knowledge about HPV-related oral lesions, awareness of HPV infection prevention measures, and compliance with vaccination, as well as patient demand for free and easy access to well-tailored and time-saving health information, the present cross-sectional study examined the accuracy of relevant YouTube videos and their suitability for mass-reach health communication and HPV vaccination promotion. A video search was performed, using keywords obtained from the Google Trends website, until 9 January 2023. Video selection and data collection were performed by independent, pre-calibrated examiners. Descriptive statistics were performed on videos' general characteristics, source reliability, popularity, information and quality, content topics, vaccination-encouraging/discouraging messages, and educational value. Pearson's correlation was calculated between educational value and all parameters. Mann-Whitney U test compared very low/low vs. medium/good/excellent educational value and HPV vaccination-encouraging vs. -discouraging videos. Most of the 97 YouTube videos analyzed were moderately accurate and reliable, 53% had moderate/good/excellent educational value, and 80% encouraged HPV vaccination, making them suitable for mass-reach communication. The limited role of oral healthcare providers in uploading relevant content, with the poor dissemination of information about HPV-related benign and malignant oral lesions, may be expanded by purposefully using YouTube and other mass media to improve patient knowledge of HPV-related oral lesions and promote HPV vaccination, which also underscores its potential beneficial oral effects.

A qualitative study to explore healthcare providers' perspectives on barriers and enablers to early detection of breast and cervical cancers among women attending primary healthcare clinics in Johannesburg, South Africa.

Low-and-middle income countries (LMICs) contribute approximately 70% of global cancer deaths, and the cancer incidence in these countries is rapidly increasing. Sub-Saharan African (SSA) countries, including South Africa (SA), bear some of the world's highest cancer case fatality rates, largely attributed to late diagnosis. We explored contextual enablers and barriers for early detection of breast and cervical cancers according to facility managers and clinical staff at primary healthcare clinics in the Soweto neighbourhood of Johannesburg, South Africa. We conducted qualitative in-depth interviews (IDIs) between August and November 2021 amongst 13 healthcare provider nurses and doctors as well as 9 facility managers at eight public healthcare clinics in Johannesburg. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis. Analysis was stratified by healthcare provider role and identified apriori around the themes of barriers and facilitators for early detection and management of breast and cervical cancers. Findings were conceptualised within the socioecological model and then explored within the capability, opportunity and motivation model of behaviour (COM-B) for pathways that potentially influence the low screening provision and uptake. The findings revealed provider perceptions of insufficient South African Department of Health (SA DOH) training support and staff rotations resulting in providers lacking knowledge and skills on cancer, screening policies and techniques. This coupled with provider perceptions of poor patient cancer and screening knowledge revealed low capacity for cancer screening. Providers also perceived opportunity for cancer screening to be undermined by the limited screening services mandated by the SA DOH, insufficient providers, inadequate facilities, supplies and barriers to accessing laboratory results. Providers perceived women to prefer to self-medicate and consult with traditional healers and access primary care for curative services only. These findings compound the low opportunity to provide and demand cancer screening services. And because the National SA Health Department is perceived by providers not to prioritize cancer nor involve primary care stakeholders in policy and performance indicator development, overworked, unwelcoming providers have little motivation to learn screening skills and provide screening services. Providers reported that patients preferred to go elsewhere and that women perceived cervical cancer screening as painful. These perceptions must be confirmed for veracity among policy and patient stakeholders. Nevertheless, cost-effective interventions can be implemented to address these perceived barriers including multistakeholder education, mobile and tent screening facilities and using existing community fieldworkers and NGO partners in providing screening services. Our results revealed provider perspectives of complex barriers to the early detection and management of breast and cervical cancers in primary health clinic settings in Greater Soweto. These barriers together appear potentially to produce compounding effects, and therefore there is a need to research the cumulative impact but also engage with stakeholder groups to verify findings and create awareness. Additionally, opportunities do exist to intervene across the cancer care continuum in South Africa to address these barriers by improving the quality and volume of provider cancer screening services, and in turn, increasing the community demand and uptake for these services.

Feasibility of tobacco cessation intervention at non-communicable diseases clinics: A qualitative study from a North Indian State.

One of the 'best buys' for preventing Non-Communicable Diseases (NCDs) is to reduce tobacco use. The synergy scenario of NCDs with tobacco use necessitates converging interventions under two vertical programs to address co-morbidities and other collateral benefits. The current study was undertaken with an objective to ascertain the feasibility of integrating a tobacco cessation package into NCD clinics, especially from the perspective of healthcare providers, along with potential drivers and barriers impacting its implementation. A disease-specific, patient-centric, and culturally-sensitive tobacco cessation intervention package was developed (published elsewhere) for the Health Care Providers (HCPs) and patients attending the NCD clinics of Punjab, India. The HCPs received training on how to deliver the package. Between January to April 2020, we conducted a total of 45 in-depth interviews [medical officers (n = 12), counselors (n = 13), program officers (n = 10), and nurses (n = 10)] within the trained cohort across various districts of Punjab until no new information emerged. The interview data wereanalyzed deductively based on six focus areas concerning feasibility studies (acceptability, demand, adaptation, practicality, implementation, and integration) using the 7- step Framework method of qualitative analysis and put under preset themes. The respondent's Mean ± SD age was 39.2± 9.2 years, and years of service in the current position were 5.5 ± 3.7 years. The study participants emphasized the role of HCPs in cessation support (theme: appropriateness and suitability), use of motivational interviewing, 5A's & 5R's protocol learned during the training & tailoring the cessation advice (theme: actual use of intervention activities); preferred face-to-face counseling using regional images, metaphors, language, case vignettes in package (theme: the extent of delivery to intended participants). Besides, they also highlighted various roadblocks and facilitators during implementation at four levels, viz. HCP, facility, patient, and community (theme: barriers and favorable factors); suggested various adaptations to keep the HCPs motivated along with the development of integrated standard operating procedures (SOPs), digitalization of the intervention package, involvement of grassroots level workers (theme: modifications required); the establishment of an inter-programmatic referral system, and a strong politico-administrative commitment (theme: integrational perspectives). The findings suggest that implementing a tobacco cessation intervention package through the existing NCD clinics is feasible, and it forges synergies to obtain mutual benefits. Therefore, an integrated approach at the primary & secondary levels needs to be adopted to strengthen the existing healthcare systems.

The role of oral and prenatal healthcare providers in the promotion of oral health for pregnant women

BackgroundHormonal alterations and lowered immunity during pregnancy aggravated by poor oral hygiene increase the risk of pregnant women of developing oral diseases. We conducted this cross-sectional study to examine the role of oral and prenatal health providers in promoting dental care for pregnant women attending primary healthcare centers (PHCs) in Saudi Arabia.MethodsAn online questionnaire was sent to a random sample of women who attended PHCs in Jeddah, during 2018–2019. From a total of 1350 women who responded to our questionnaire, 515 women reported having a dental visit before pregnancy. These women comprised our study sample. Bivariate analyses and multiple logistic regression models were conducted to examine associations between oral practices of dental and prenatal health providers (exposures) and women’s utilization of dental care during pregnancy (outcome). Covariates included age, education (< 12 years of education, 12 years of education, and > 12 years of education), family income (≤ 5,000, 5,001–7,000, 7,001–10,000, and > 10,000 Saudi Riyals), health insurance (yes/no), nationality (Saudi Arabian/non-Saudi Arabian), and presence of dental problems, such as toothache, dental caries, gingival inflammation, and the need for dental extractions.ResultsOnly 30.0% of women were informed by a dentist during their dental visit before pregnancy about the importance of visiting a dentist during pregnancy. About 37.0% of women were asked about oral health, 34.4% were informed about the importance of dental care during pregnancy, and 33.2% had their mouths inspected by prenatal health providers. Women informed by dentists about the importance of dental visits during pregnancy were twice as likely (Odds ratio [OR]: 2.42, 95% confidence interval [CI]: 1.63–3.60) to visit a dentist during pregnancy. Women who were referred to dentists, had their mouth inspected, or were advised to visit a dentist during pregnancy by prenatal providers were 4.29 (95% CI: 2.67–6.88), 3.79 (95% CI: 2.47–5.82), and 3.37 (95% CI: 2.16–5.27) times as likely to visit a dentist during pregnancy.ConclusionThe partaking of oral and prenatal healthcare providers in evidence-based oral health promotion practices, antenatal-dental collaboration, and closing the referral loop increase pregnant women’s access to and utilization of preventive and treatment dental services.