Seeking Health Care Research Articles

Hard-To-Reach and Hidden Groups in Health-Related Research-A Scoping Review.

The aim of this scoping review was to identify hard-to-reach and hidden groups in health-related research and to understand the recruitment methods used with these groups. The presented scoping review has an exploratory perspectiveand was conducted in accordance with Arksey and O'Malley's framework and the PRISMA-ScR guidelines. A comprehensive search of CINAHL and MEDLINE databases was performed for studies published up to November 2022. The searches were updated in December 2024. Relevant papers were identified via specific search terms and inclusion and exclusion criteria. Two authors independently assessed eligible literature and extracted relevant data, which was analysed and synthesised to answer the research questions. The analysis method used was descriptive analysis with quantification. Overall, 1024 studies were screened. The included studies were published between 2001 and 2022. A total of 41 studies were included in the review. In this data, groups were defined mostly as hard-to-reach and hidden. The groups were divided into eight categories: LGBTQ+ community, intoxicant users, sex workers and their clients, marginalised groups, mental health care seekers and users, impaired persons, people living outside their original home country and victims of abuse or neglect. Recruitment methods were varied, with snowball sampling, respondent-based sampling and websites being the most used. This review provides insight into the current knowledge on hard-to-reach and hidden study groups. In studies targeting hard-to-reach and hidden groups, the use of concepts is variable and inconsistent. In clinical nursing practice, it is important to identify hidden and hard-to-reach groups, as the goal of equality is to improve the health and well-being of all individuals, including marginalised groups. Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis ex-tension for Scoping Reviews (PRISMA-ScR). No patient or public contribution.

Qualitative Study of Healthcare Seeking Behavior and Development of Behavioural Nudges for a Nutrition Program in Gombe State, Nigeria

Objective: This qualitative study aimed to identify and explain healthcare seeking behaviours among caregivers of young children and apply these findings to develop a mobile phone-based messaging intervention to encourage sustained attendance at a community-based management of acute malnutrition (CMAM) program in Gombe state, Nigeria. Design: Researchers conducted focus group discussions (n=6) and key informant interviews (n=3) with 33 subjects. Transcripts were independently coded and thematic analysis was conducted to gain an understanding of the facilitators, barriers, and motivators shaping caregivers’ decisions to attend health services for malnourished children, as well as access to and use of mobile phones. Participants: Focus groups and interviews were conducted with caregivers of children aged 6-59 months living within travelling distance of three CMAM sites in Gombe state, Nigeria. Results: Barriers to seeking health services included high costs; perceptions of poor quality of care, including poor treatment by health workers; and female caregivers’ limited autonomy. Despite barriers, participants recommended seeking hospital care for a malnourished child. Participants described widespread mobile phone use and recommended messages emphasising that CMAM services are free, conveying respect for caregivers, and reminding caregivers to continue making an effort to attend the CMAM program even as their child began to appear healthier. Conclusions: This study provides a framework for developing contextually salient behavioural nudges for child health and nutrition programs which, in combination with other community outreach strategies, could help motivate and sustain care seeking behaviour.

Breast and cervical cancer screening among women at reproductive age in Cambodia: A secondary analysis of Cambodia Demographic and Health Survey 2022.

Breast and cervical cancers are the most prevalent diagnosed in women worldwide, significantly contributing to maternal morbidity and mortality. We examined socio-demographic and behavioral factors associated with breast and cervical cancer screening among Cambodian women aged 15-49 years old. We analyzed women's data from the 2022 Cambodia Demographic and Health Survey (CDHS). In total, 19,496 women were interviewed. Multiple logistic regression was performed using STATA V17 to examine factors associated with breast and cervical cancer screening. The proportion of breast and cervical cancer screenings was 10.6% and 15.3%, respectively. After being adjusted, factors independently associated with breast cancer screening included age group 20-29 years [AOR = 2.51; 95% CI: 1.55-4.06], 30-39 years [AOR = 4.34; 95% CI: 2.66-7.09], and 40-49 years [AOR = 4.66; 95% CI: 2.81-7.71], higher education [AOR = 1.92; 95% CI: 1.26-2.93], exposure media [AOR = 1.66; 95% CI: 1.32-2.10], and rich wealth quintile [AOR = 1.50; 95% CI: 1.25-1.80]. Similarly, the odds of having cervical cancer screening were age group 20-29 years [AOR = 2.88; 95% CI: 1.76-4.71], 30-39 years [AOR = 5.94; 95% CI: 3.58-9.83], and 40-49 years [AOR = 7.61; 95% CI: 4.55-12.73], higher education [AOR = 1.55; 95% CI: 1.55-2.73], exposure media [AOR = 1.62; 95% CI: 1.35,1.95], and rich wealth quintile [AOR = 2.14; 95% CI: 1.78-2.5f8]. In conclusion, this study shows the low screening proportion for both breast and cervical cancers, and it also highlights that socio-economic factors are significantly important in determining the health care seeking for these two main cancer screening services among women aged 15-49 years in Cambodia. Therefore, increase of exposure media with health education focusing on these cancer screenings should be made better accessible to women, particularly those of low socio-economic status.

Prevalence of selected chronic diseases, health seeking behaviour and associated factors among the elderly workers of a selected district of Sri Lanka

Introduction: Sri Lankan demographic transition has shifted the country to a fast-ageing population. Consequently, elderly in labour force will be noteworthy. Ageing increases the prevalence of non-communicable diseases. Hence, its prevalence, health seeking behaviour and associated factors need to be sought to improve the health of elderly workforce. Objectives: To describe the sociodemographic and work-related characteristics of elderly workers, health status, health seeking behaviour and association between the health seeking behaviour and sociodemographic and work-related characteristics in Gampaha District of Sri Lanaka Methods: A community-based descriptive cross-sectional study was conducted using multistage cluster sampling in Gampaha District, Sri Lanka among 835 elderly workers who met the operational definition and eligibility criteria. Data were collected using a pretested interviewer-administered questionnaire, covering sociodemographic and occupational details, and information on chronic illnesses and health-seeking behaviour. Bivariate analysis was carried out using Chi--squared test, considering a p-value of 0.05 as statistically significant. Results: Majority of the workers (78.4%; n=655) were having at least one chronic illness and the occupation of 58% of them was affected by their chronic illness. For acute and chronic illness, 48.1% were taking treatment from private medical centres. The healthcare seeking behaviour for chronic conditions among the elderly was influenced by factors such as educational level, income, marital status, living arrangements, skill level and working patterns. Conclusions & Recommendations: The findings emphasize the need for policies and interventions that address socio-demographic disparities in healthcare access by promoting family support, insurance schemes, and adopting the health care facility provision according to the workplaces and working patterns.

Work Related Health Problems and Healthcare Seeking Among Tea Garden Worker

Background: Tea, derived from the Camellia sinensis plant, is a globally consumed beverage with a rich history. Despite its widespread production, smaller gardens produce unique teas highly valued by enthusiasts. The tea industry in Bangladesh, particularly in Sylhet, plays a pivotal role in the economy but is plagued by challenges such as work-related health issues among its predominantly marginalized and tribal labor force. This study aimed to explore the health and lifestyle challenges faced by tea workers in Sylhet. Methods: A cross-sectional study was conducted in three tea gardens in Sylhet, focusing on socio-demographic characteristics, work-related health problems, and healthcare-seeking behaviors. Data were collected from 255 participants using a semi-structured questionnaire, and statistical analyses, including Chi-Square test, were performed using SPSS version 26. Results: The socio-economic profile revealed a predominantly female, Hindu, and illiterate workforce with low income. Musculoskeletal disorders (MSDs) were prevalent, affecting 77.6% of participants, with lower back pain being the most common. Common diseases, injuries, and respiratory issues were reported. Allopathic treatment was preferred by 78% of respondents. Significant associations were found between MSDs and age, education, smoking, and drug use. Job-related factors like nature of work and weekly working hours also showed significant associations (p<0.05). Conclusion: The study highlights the multifaceted challenges faced by tea garden workers, emphasizing the need for targeted interventions considering socio-demographic and occupational factors. Insights from this research can inform policies and healthcare strategies to improve the well-being of this vulnerable population. Further research and collaborative efforts are warranted to address the complexities of the tea industry and promote the health and rights of its workforce. JOPSOM 2023; 42(2): 36-42

Management of microbial keratitis by private pharmacies in Uganda: a study of knowledge, attitude, and practice.

Purpose To determine the knowledge, attitude, and practice of pharmacy attendants in the management of microbial keratitis. Methods This mixed-methods study was conducted in selected pharmacies and drug shops located in Mbarara City between March and May 2022. We administered questionnaires assessing the knowledge, attitudes, and practices (KAP) related to microbial keratitis (MK) to 140 pharmacy attendants (PAs) in the drug shops and pharmacies. We also conducted 40 in-depth interviews (IDI) and three focus group discussions (FGD) with pharmacy attendants to discuss practices, challenges, and opportunities to improve the management of MK. Results Of the 140 pharmacy attendants, almost half (49.29%) reported that they were not confident when making diagnoses in patients with eye problems, and 19.29% were uncertain of which drug to prescribe. In the IDIs and FGDs, the pharmacy attendants reported that they receive and manage patients with MK. Some immediately refer any patients they receive with eye complaints without prescribing any medication while others only refer those who are not responding to medication. The challenges faced in managing patients with MK included inadequate knowledge of managing eye diseases including MK, patients presenting with severe diseases because of delays in seeking healthcare, and the use of traditional eye medicine. The pharmacy attendants suggested ways of improving the management of MK and other eye diseases in the community including community sensitisation on eye diseases and conducting continued professional development lecture sessions on MK in pharmacies, drug shops, and clinics. Conclusion The study showed that probable MK was a common presentation among patients seeking to buy drugs from pharmacies and drug shops. Pharmacies are key stakeholders in the health seeking journey of patients and hence need to be supported through capacity building and strengthening the referral network to improve the outcomes of patients with eye diseases and MK.

Ensuring culturally competent nursing care for LGBT+ people.

People who are lesbian, gay, bisexual, transgender and other sexual and gender minorities (LGBT+) can encounter various challenges when seeking healthcare. For example, many LGBT+ individuals experience discrimination and social stigma from healthcare professionals, leading to feelings of mistrust. This might manifest as explicit homophobia or transphobia, inappropriate questioning, or a lack of consideration for the sensitivities around LGBT+ identities. Similarly, healthcare organisations may have policies that lack inclusivity, with administrative forms and procedures that do not consider diverse sexual orientations and gender identities. Nurses are increasingly recognising the importance of providing inclusive care for individuals who identify as LGBT+, which involves being attentive to their specific needs. This article examines the barriers that may be encountered by LGBT+ individuals in healthcare services and offers recommendations for how nurses can deliver culturally sensitive healthcare to the LGBT+ community.

Considerations and experiences with healthcare-seeking during the first COVID-19 lockdown in Denmark

Aim To (1) examine considerations before and experiences with GP contact during the first COronaVIrus Disease 2019 (COVID-19) lockdown among Danish citizens; (2) analyse the associations with sex, age, chronic disease, and socioeconomic factors; and (3) explore changes in healthcare-seeking behaviour post-pandemic. Method A total of 100,000 Danes aged 20 years or older, randomly selected in the general population, were invited to participate in a survey examining considerations and experiences with healthcare seeking during the first COVID-19 lockdown. Data were collected in spring 2022 and linked to register data on socioeconomic factors. Descriptive statistics and multivariable logistic regression models were applied. Results Of the 27,369 eligible individuals, 18% reported a need to contact their GP. Being worried about burdening the healthcare system was most frequently reported (45%), followed by being in doubt about acceptable contact reasons (33%), and concern about infection (24%). Although 44% of those who needed to contact their GP found the digital solutions advantageous, individuals frequently found it difficult to discuss symptoms by telehealth (29%) and that they were examined less thoroughly. Generally, women, younger people, and individuals with lower socioeconomic status were more likely to be worried and report difficulties with contact to general practice. Some 86% of the respondents reported no changes in healthcare-seeking behaviour post-pandemic. Conclusion The results may assist in the organisation of healthcare in case of future lockdowns. Yet, the COVID-19 pandemic has only slightly affected the healthcare-seeking behaviour in the Danish general population.

Gaps in Mental Health Care-Seeking Among Health Care Providers During the COVID-19 Pandemic - United States, September 2022-May 2023.

Health care workers experience substantial chronic stress, burnout, and mental distress, and the COVID-19 pandemic might have exacerbated these conditions. To identify ways to improve mental health care-seeking among this population, mental health symptoms, care-seeking, and self-reported barriers to seeking mental health care among U.S. health care providers during the pandemic were studied. During September 2022-May 2023, 2,603 primary care physicians, pediatricians, nurse practitioners, and physician assistants participated in a national Internet panel survey. Approximately one half (45.4%) of participants reported that they did not need mental health care, and only one in five (20.3%) had sought care. One quarter (25.6%) of providers reported mental distress severe enough to meet diagnostic criteria for psychopathology. Among these providers, only 38% reported seeking care; 20.1% indicated that they did not need care, despite severe symptoms. The average number of years in practice was lower for providers reporting care-seeking. Providers who identified as female were also more likely to report care-seeking. The most frequently reported barriers to care-seeking included difficulty getting time off from work, cost of care, and concerns about confidentiality. Increased pandemic-related work stressors were associated with increased symptom severity, but support from work supervisors mitigated these effects. Organizational human resources practices, supervisor training on managing employee stress, and public health messaging to normalize mental health care-seeking and its effects on licensing might help address gaps in provider care-seeking and improve patient outcomes.

Delays in health care seeking for diarrheal disease and associated factors among caregivers of under five children in health centers of northwest Ethiopia: a mixed-method study

BackgroundApproximately 70% of child deaths due to diarrhea are caused by a lack of timely healthcare. However, there was little evidence of factors associated with delays in seeking health care for patients with diarrheal diseases in the study area. Therefore, this study aimed to investigate delays in seeking healthcare for children with diarrhea and identify associated factors among caregivers in health centers of Northwest Ethiopia.Method and materialsAn institution-based mixed study method was conducted from May to June 2022. Quantitative data were collected from 374 participants who were selected by systematic random sampling using a structured interviewer-administered questionnaire and chart review. The data were analyzed using the Statistical Package for Social Science software version 25. Bivariable and multivariable logistic regression models were used to identify associated factors. Variables with a p- value < 0.05 in the multivariable analysis were considered to be significantly associated. Qualitative data were collected from participants in waiting area after receiving treatments via in-depth interviews and analyzed using open-source software. The qualitative data were transcribed, translated, coded, thematized, and interpreted accordingly.ResultsIn this study, 53.48% of patients experienced delays in seeking healthcare for diarrhea. A large family size (adjusted odds ratio (AOR) = 2.64, 95% CI: 1.26–5.4), poor knowledge about diarrhea danger signs (AOR = 3.25, 95% CI: 1.6–6.6), difficulty paying for treatment (AOR = 2.95, 95% CI: 1.6–5.3), not visiting health facilities as the first response to diarrhea (AOR = 3.94, 95% CI: 1.96–7.9), only diarrhea (AOR = 2.39, 95% CI: 1.01–5.63), and no information about early healthcare seeking (AOR = 4.88, 95% CI: 1.91–12.43) were identified; moreover, from the qualitative findings, mothers’ perceptions of the illness were mild, poor service provision, and economic problems were determinants of delay. Awareness, barriers, compliance, and perception emerged as themes.ConclusionThe prevalence of delays in seeking healthcare for children with diarrhea was high. This poses a negative health risk to the lives of children and their caregivers. A large family size, poor knowledge about diarrhea danger signs, difficulty paying for treatment, and many others were factors associated with delayed health care seeking. Hence, the government and other concerned stakeholders should give due emphasis to tackling the identified causes of delay in seeking health care for children under five years of age with diarrhea by diverting community focus toward timely care seeking and disease prevention.

Wealth-related inequality in women healthcare-seeking behaviour for under-five children illness in Afghanistan: evidence from 2022 Afghanistan Multiple Indicator Cluster Survey

BackgroundThis study examined the wealth-related inequality in women healthcare seeking behaviour for under-five children illness in Afghanistan and its determinants.MethodsData of 32409 mothers/caregivers of children under-five were extracted from Afghanistan Multiple Indicator Cluster Survey conducted in 2022. Wealth-related inequalities in women healthcare seeking behaviour for under-five children illness was investigated using Erreygers and Wagstaff concentration indices and curve. Contributions of selected factors to the total inequality were estimated using the Erreygers decomposition technique.ResultsThe Erreygers and Wagstaff normalized concentration indices for women healthcare seeking behaviour for under-five children illness was 0.040; p < 0.000 and 0.042; p < 0.000 respectively. Hence, women healthcare seeking behaviour for children under-five illness was heavily concentrated among women from richer households and disfavoured women from poorer households. The decomposition findings revealed that household wealth (265%), residency in rural areas (-125%), access to mobile phone (-83%), access to internet (67%) and mothers’ education (26%) were the major determinants of pro-rich inequalities.ConclusionPolicy makers, the private and development actors in Afghanistan should promote inclusive income generation interventions and healthcare awareness programmes, including women from poor households to eliminate wealth-related inequalities in women healthcare seeking behaviour. There is need for decentralizing health facilities in both rural and urban areas to improve equitable access to healthcare services. There is scope for disseminating health education through mobile phones and internet, reaching out to all areas to improve knowledge on children’s illnesses and subsequently reduce inequalities in women health seeking behaviours.

Smoking status, symptom significance and healthcare seeking with lung cancer symptoms in the Danish general population

This study analyses the associations between smoking status and perceived symptom significance (concern and influence on daily activity) among individuals with possible lung cancer symptoms and investigate the influence of symptom significance on healthcare seeking among individuals with different smoking status. A nationwide survey with 21,920 randomly selected individuals aged ≥40 years included questions about lung cancer symptoms, symptom concern and influence on daily activities, GP contact, and smoking status. Descriptive statistics and multivariable regression models were applied. Overall, individuals who currently smoked were more likely to perceive their lung cancer symptoms as significant, and individuals who reported high symptom significance were more likely to seek healthcare with both specific and non-specific symptoms. The significance of symptoms appeared to have less pronounced effect on prompting healthcare seeking among individuals with a history of current smoking. This implies that they may benefit from support and encouragement to seek care.

Unchained Care: A Public Health Perspective on Ending Shackling of Incarcerated Patients Seeking Health Care, a Policy Statement Adopted by the American Public Health Association.

Unchained Care: A Public Health Perspective on Ending Shackling of Incarcerated Patients Seeking Health Care, a Policy Statement Adopted by the American Public Health Association.

Factors Associated with Dengue Outbreaks in Pulau Pinang from the eDengue Database 2023: A Cross-Sectional Study.

Dengue is now endemic in over 100 countries, with Asia bearing over 70% of the global burden. In Malaysia, dengue cases have increased dramatically, particularly in Pulau Pinang, where cases rose from 1,621 in 2022 to 7,343 in 2023. To examine factors associated with dengue outbreaks in Pulau Pinang in 2023 by comparing outbreak cases with single cases. Cross-sectional study using eDengue database, the Malaysian National Dengue Registry. The study included 1,106 confirmed dengue cases, with 553 categorised as outbreak cases and 553 as single cases. Significant associations were found between dengue outbreaks and Priority Locality 1 (areas with Uncontrolled Outbreaks/ Hotspots/ Recurrent Outbreaks/ Dengue Deaths in the previous year) (AOR: 0.15, 95% CI: 0.06,0.37, p<0.001), Aedes Index ≥1% (AOR: 1.35, 95% CI: 1.02,1.77, p=0.031), patients initially visiting government clinics (AOR: 1.63, 95% CI: 1.10,2.43, p=0.015), hospitalized dengue patients (AOR: 0.70. 95%CI: 0.52,0.96, p=0.029), the time taken from notification to source reduction (AOR: 0.57, 95% CI: 0.50,0.66, p<0.001) and time taken from notification to investigation (AOR: 2.40 95%CI: 1.77,3.24, p<0.001). This study identifies key factors associated with dengue outbreaks in Pulau Pinang such as Aedes Index, Priority Locality 1 areas and initial visits to government clinics. These findings underscore the need for targeted vector control and early intervention in high-risk areas to reduce outbreak risk. Early healthcare seeking behavior and timely intervention are critical in managing the spread of dengue. Further research is needed to explore additional factors and improve public health strategies.

Care-seeking in the presence of signs of sexually transmitted infections in Moroccan women: A comparison between the COVID-19 pandemic and pre-pandemic era

Background &amp; Aim: The emergence of COVID-19 has had significant effects on access to screening services for sexually transmitted infections (STIs). This study aimed to describe the effects of the COVID-19 pandemic on care-seeking in the presence of signs of STIs among women of childbearing age in the Essaouira province of Morocco between April and June 2020. Materials &amp; Methods: A comparative and cross-sectional approach was used for the objectives of the study. It was a comparative analysis of the programmatic data from April, May, and June 2019 and from April, May, and June 2020. In addition, data were collected from women of childbearing age in 2021 via a questionnaire. Results: Among the 1,100 selected women, 425 who reported having experienced symptoms of STIs during the COVID-19 pandemic were interviewed. 72.2% reported seeking health care from a qualified professional. The study revealed a relationship between women's healthcare seeking during the COVID-19 pandemic (p&lt;0.05) and factors such as place of residence, education, marital status, socioeconomic status, and distance from healthcare facilities. The analysis of the distribution of data regarding syndromic reporting of STIs, between 2019 and 2020, revealed a difference of 17.2%. Conclusion: The COVID-19 pandemic hindered the search for treatments for signs of STIs in women of childbearing age, with a 17.2% decrease in cases in the second quarter of 2020 compared to the same period in 2019. However, the role of healthcare professionals remains crucial for maintaining awareness, screening, and treatment of these infections.

The effectiveness of two doses of recombinant hepatitis E vaccine in response to an outbreak in Bentiu, South Sudan: a case-control and bias indicator study.

Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis, particularly in Asia and Africa, where HEV genotypes 1 and 2 are prevalent. Although a recombinant vaccine, Hecolin, is available, it has not been used to control outbreaks. The licensed three-dose regimen might pose challenges for it to be an impactful outbreak control tool. Our study aimed to estimate the effectiveness of two doses of Hecolin in the context of the first-ever reactive use of the vaccine. We conducted a case-control study during an HEV outbreak in the Bentiu internally displaced persons camp, South Sudan. Patients with acute jaundice syndrome (suspected cases) seeking care at the Médecins Sans Frontières hospital were screened for study eligibility. Eligible participants were those that had been eligible for vaccination (ie, living in the camp and aged 16-40 years). Confirmed cases were defined as individuals who tested positive for hepatitis E by RT-PCR or anti-HEV IgM ELISA. Each case was matched to six controls by age, sex, pregnancy status, and residence. Self-reported vaccination status was verified through vaccination cards. The primary analysis was two-dose vaccine effectiveness, which we estimated with a matched case-control design using conditional logistic regression models. In secondary analyses we estimated vaccine effectiveness using a test-negative design and the screening method. We used test-negative cases and their matched controls as a bias indicator analysis to help quantify potential health seeking behaviour biases. Between May 10 and Dec 30, 2022, we identified 859 patients with suspected hepatitis E. Of these, 201 met the eligibility criteria and 21 cases had laboratory confirmed hepatitis E. Among the confirmed cases, 10 (48%) were unvaccinated compared with 33 (27%) of 121 matched controls. In the primary analysis we estimated an unadjusted two-dose vaccine effectiveness of 67·8% (95% CI -28·6 to 91·9), and a two-dose vaccine effectiveness of 84·0% (-208·5 to 99·2) after adjustment for potential confounders. The bias indicator analysis suggested that test-negative cases might have been more likely to have been vaccinated than their matched community controls due to different health-care seeking behaviours, potentially meaning underestimation of effectiveness estimates. The test-negative design, which uses facility-matched controls, led to an adjusted two-dose effectiveness of 89·4% (56·4 to 98·0). Despite the small sample size, our estimates provide evidence of effectiveness of a two-dose regimen against HEV genotype 1 during a protracted outbreak, supporting its use in similar contexts. Médecins Sans Frontières.

Parental stress and mental health among transgender parents

Background Parental stress impacts individual health and the development of the next generation, but there is a lack of comprehensive research on parental stress among transgender parents in China. This study is the first to investigate parental stress and mental health among transgender parents and identify potential influencing factors. Methods We designed a cross-sectional survey that recruited a representative sample of 647 transgender parents. A validated questionnaire was used to investigate parental stress, depression, anxiety, and their associated factors, including parent factors (gender dysphoria, time of coming out, depression, and anxiety) and situational factors (family violence, partner violence, relationship with partner, discrimination and family income). Linear regression models were used to explore the influencing factors of parental stress among transgender parents, a structural equation model (SEM) was established to explore the possible pathways between these factors and parental stress, and network analysis was conducted to determine primary symptoms and central risk factors. Results The average parental stress score was 50.4 ± 8.02. 92.7% of participants exhibited depressive tendencies and 73.7% showed anxiety tendencies. Lower family income (p < 0.001), coming out after having a child (Coefficient (Coef.) = 2.6, 95% confidential interval (CI) = 1.174 ∼ 4.027), family violence (Coef. = 3.582, 95%CI = 2.372 ∼ 4.791), partner violence (Coef. = 4.199, 95%CI = 2.998 ∼ 5.401), being discriminated during seeking of childbearing health care (Coef. = 3.29, 95%CI = 2.054 ∼ 4.526), poor relationship with partner (fair relationship: coef. = −3.205, 95%CI = −4.86∼−1.551; good relationship: coef. = −5.372, 95%CI = −6.886∼−3.858), depression (Coef. = 5.873, 95%CI = 3.557 ∼ 8.189), and anxiety (Coef. = 5.705, 95%CI = 4.368 ∼ 7.042) were significantly associated with higher parental stress. Through the pathway analysis, the direct or indirect effects of parent factors and situational factors on parental stress were observed. Additionally, network analysis revealed that gender dysphoria, family violence, psychological abuse, and various anxiety types as central risk factors, with two gender dysphoria symptoms showing the strongest direct relationship to stress. Conclusions Transgender parents experience significant parental stress influenced by mental health, sociodemographic, transgender-specific, family, and socio-environmental factors. Enhanced family support and a more inclusive social environment are crucial for reducing stress and improving the well-being of transgender parents and their children.

Using a Photovoice Intervention to Teach Nursing Students About Living Homeless

Background: Over 582,000 people live homeless in the United States daily. They have more health problems and are more likely to receive inadequate health care than people with adequate housing. They also report that nurses treat them uncivilly when they seek health care. Nurse educators teach students to care and advocate for those who are unhoused. Photovoice has been used as a strategy to teach nursing students, but we found no studies using this technique to teach about homelessness. The purpose of this study was to develop and test a photovoice intervention to teach nursing students what it is like to live with unstable living conditions.Method: The convenience sample for this mixed methods design consisted of 88 undergraduate nursing students in a health assessment course.Results: Scores for the intervention group improved, with a significant difference between groups in attitudes toward poverty. Students expressed a better understanding of the experience of living homeless, gained awareness of the challenges faced by those who live homeless, and stated this awareness will impact their future nursing practice. They further identified the importance of knowing what resources unhoused individuals may need to support their overall health and well‐being.Conclusion: Photovoice is an effective method to teach students about homelessness.

Reproductive health care seeking behavior in Bangladesh: Asystematic literature review.

Maternal health, in terms of pregnancy and childbirth, is an important aspect of women's reproductive health and remains a public health concern in underdeveloped countries of the world. Reproductive health care seeking behavior (RHSB), in both men and women in society, is influenced by a variety of social and environmental factors that needs to be summarized. This review aims to enhance understanding and perception of services in relation to RHSBs in several domains such as antenatal care (ANC), delivery care, postnatal care (PNC), and family planning (FP) services, for married women of reproductive age in Bangladesh. In major databases, for example, Medline, Ovid, PubMed, Web of Science, ProQuest and Google Scholar following keywords, timeline set as 2010 up to December 30, 2022. Articles that included discussion on married women of reproductive age, and their type of care seeking behavior for reproductive health. A systematic literature search was carried out and expected outcome was health care seeking behavior in the aspects of ANC, delivery care, PNC, and FP services. A data extraction form and quality appraisal form were used for data on RHSB of married women of the reproductive age group in Bangladesh and associated factors. A total of 245 articles were retrieved from databases; stepwise screening was done and finally 23 full-text articles were included for analysis. Descriptive statistics were used based on the included articles for narrative synthesis. In the selected articles, 17 (73.91%) were cross-sectional studies and more than half discussed both urban and rural women. Ante- and postnatal visits have proven to have positively influenced overall RHSB, as seen in Bangladesh. Grass root level workers play a major role in upgrading RHSB in women. Many factors limit rural access to mother and child health services including distance of the health facility and cost of the health service. In particular, education level, women's autonomy in family decision making and distance from health service can be considered as factors influencing RHSBs in Bangladesh. Exposure to mass media and TV watching are likely to positively impact RHSB patterns for women in Bangladesh.

Barriers and facilitators for healthcare access among immigrants in Japan: a mixed methods systematic review and meta-synthesis.

While Japan provides universal healthcare, immigrants may experience hampered access to healthcare. A comprehensive review of immigrant healthcare access is also lacking. This systematic review aims to examine barriers and facilitators of healthcare access among immigrants in Japan. We searched for literature published in English and Japanese until January 9, 2024. Studies were included if they assessed factors influencing any stage of immigrants' healthcare access, such as perceiving needs, seeking, reaching, utilizing healthcare and the consequences of healthcare, as defined by the Levesque framework. We performed a thematic analysis to further identify categories (PROSPERO: CRD42023418554). After screening 2791 articles, we identified 67 studies (40 quantitative, 23 qualitative, 4 mixed methods) meeting eligibility criteria. Limited healthcare information led immigrants to seek alternative information sources and affected immigrants' perceived healthcare needs. Longer duration of stay improved access to healthcare information. Cultural and healthcare system differences affected healthcare seeking. Reaching and utilizing healthcare were hindered by heavy workloads, undocumented status, financial hardship, and limited insurance but were facilitated by support from family and friends. The healthcare system was often insufficient to support immigrants' language and cultural needs leading to dissatisfaction and poor compliance. Findings highlight the critical importance of a multidimensional approach to support immigrants in Japan, ranging from improving healthcare information access to creating immigrant-friendly health systems. More research is needed on the healthcare access among vulnerable immigrants, such as undocumented and low-skilled labor immigrants and children. No specific funding source supported this study.