Informal Health Research Articles

Mental Health Carers’ Support Experiences in Australia

Informal mental health carers play a crucial role in supporting individuals with depression and anxiety. However, there is a lack of knowledge on how to effectively support these carers and promote their well-being. This mixed-method study aimed to explore the support needs of carers of a person with depressive or anxiety symptoms, living in Australia. Sixty-seven carers (female 76 %, median age 48) completed an online survey, and 22 completed semi-structured interviews about their support experiences. Over half of the survey respondents reported high levels of psychological distress on the Kessler Psychological Distress Scale (K10), and 63% reported understanding and adjusting to the caregiving role as the most needed areas of support, as identified on the Caregiver Perspective Questionnaire (CPQ). Through thematic analysis of the interviews, four key themes emerged describing carers’ support experiences and needs: connecting with formal services, responding to the care-recipient, connecting socially, and caring for the self. The analysis also found that time constraints and stigma can be significant support barriers for these carers. This is the first time that a study has investigated the support experiences and needs of carers of a person with depressive or anxiety symptoms, living in Australia. The findings contribute to current literature on mental health carers and offer novel and tangible insights into future research and support opportunities.

Prevalence and predictors of residual antibiotics in children's blood in community settings in Tanzania

ObjectivesChildren account for a significant proportion of antibiotic consumption in low- and middle-income countries, with overuse occurring in formal and informal health sectors. This study assessed the prevalence and predictors of residual antibiotics in the blood of children in the Mbeya and Morogoro regions of Tanzania. MethodsThe cross-sectional community-based survey used two-stage cluster sampling to include children aged under 15 years. For each child, information on recent illness, healthcare-seeking behaviour, and use of antibiotics, as well as a dried blood spot sample, were collected. The samples underwent tandem mass spectrometry analysis to quantify the concentrations of 15 common antibiotics. Associations between survey variables and the presence of residual antibiotics were assessed using mixed-effects logistic regression. ResultsIn total, 1742 children were surveyed, and 1699 analysed. The overall prevalence of residual antibiotics in the blood samples was 17.4% (296/1699), the highest among children under the age of 5 years. The most frequently detected antibiotics were trimethoprim (144/1699; 8.5%), sulfamethoxazole (102/1699; 6.0%), metronidazole (61/1699; 3.6%), and amoxicillin (43/1699; 2.5%). The strongest predictors of residual antibiotics in the blood were observed presence of antibiotics at home (adjusted odds ratio [aOR] = 2.9; 95% CI, 2.0–4.1) and reported consumption of antibiotics in the last 2 weeks (aOR = 2.5; 95% CI, 1.6–3.9). However, half (145/296) of the children who had residual antibiotics in their blood, some with multiple antibiotics, had no reported history of illness or antibiotic consumption in the last 2 weeks, and antibiotics were not found at home. DiscussionThis study demonstrated a high prevalence of antibiotic exposure among children in Tanzanian communities, albeit likely underestimated, especially for compounds with short half-lives. A significant proportion of antibiotic exposure was unexplained and may have been due to unreported self-medication or environmental pathways. Incorporating biomonitoring into surveillance strategies can help better understand exposure patterns and design antibiotic stewardship interventions.

Fidelity of implementation of national guidelines on malaria diagnosis for children under-five years in Rivers State, Nigeria

BackgroundMalaria is still a disease of global public health importance and children under-five years of age are the most vulnerable to the disease. Nigeria adopted the “test and treat” strategy in the national malaria guidelines as one of the ways to control malaria transmission. The level of adherence to the guidelines is an important indicator for the success or failure of the country’s roadmap to malaria elimination by 2030. This study aimed to assess the fidelity of implementation of the national guidelines on malaria diagnosis for children under-five years and examine its associated moderating factors in health care facilities in Rivers State, Nigeria.MethodsThis was a descriptive, cross-sectional study conducted in Port Harcourt metropolis. Data were collected from 147 public, formal private and informal private health care facilities. The study used a questionnaire developed based on Carroll’s Conceptual Framework for Implementation Fidelity. Frequency, mean and median scores for implementation fidelity and its associated factors were calculated. Associations between fidelity and the measured predictors were examined using Mann Whitney U test, Kruskal Wallis test, and multiple linear regression modelling using robust estimation of errors. Regression results are presented in adjusted coefficient (β) and 95% confidence intervals.ResultsThe median (IQR) score fidelity score for all participants was 65% (43.3, 85). Informal private facilities (proprietary patent medicine vendors) had the lowest fidelity scores (47%) compared to formal private (69%) and public health facilities (79%). Intervention complexity had a statistically significant inverse relationship to implementation fidelity (β = − 1.89 [− 3.42, − 0.34]). Increase in participant responsiveness (β = 8.57 [4.83, 12.32]) and the type of malaria test offered at the facility (e.g., RDT vs. no test, β = 16.90 [6.78, 27.03]; microscopy vs. no test, β = 21.88 [13.60, 30.16]) were positively associated with fidelity score.ConclusionsThis study showed that core elements of the “test and treat” strategy, such as testing all suspected cases with approved diagnostic methods before treatment, are still not fully implemented by health facilities. There is a need for strategies to increase fidelity, especially in the informal private health sector, for malaria elimination programme outcomes to be achieved.

Opportunities in Mental Health Support for Informal Dementia Caregivers Suffering from Verbal Agitation

People with dementia (PwD) often present verbal agitation such as cursing, screaming, and persistently complaining. Verbal agitation can impose mental distress on informal caregivers (e.g., family, friends), which may cause severe mental illnesses, such as depression and anxiety disorders. To improve informal caregivers' mental health, we explore design opportunities by interviewing 11 informal caregivers suffering from verbal agitation of PwD. In particular, we first characterize how the predictability of verbal agitation impacts informal caregivers' mental health and how caregivers' coping strategies vary before, during, and after verbal agitation. Based on our findings, we propose design opportunities to improve the mental health of informal caregivers suffering from verbal agitation: distracting PwD (in-situ support; before), prompting just-in-time maneuvers (information support; during), and comfort and education (social & information support; after). We discuss our reflections on cultural disparities between participants. Our work envisions a broader design space for supporting informal caregivers' well-being and describes when and how that support could be provided.

Bridging the knowledge gap! Health outcomes in informal e-waste workers.

Although several studies analyzed the impact of e-waste recycling on human health, most publications did not differ between e-waste workers and bystanders, such as residents. This could lead to an underestimation of health effects in workers. In addition, frequently reported surrogate findings do not properly reflect clinical significant health outcomes. The aim of this review was to analyze the direct health effects of informal e-waste recycling in informal e-waste workers. According to PRISMA guidelines, we systematically searched 3 databases (Embase®, PubMed®, Web of Science) for studies from low- and middle-income countries published in German or English between 1980 and 1 November 2021. Of the 2613 hits, 26 studies (cross-sectional, longitudinal and case-control studies) met the specified criteria and were included. We categorized the results into hormonal, respiratory, renal, cardiovascular, musculoskeletal health and general symptoms in informal e-waste workers. Exposure to e-waste was associated with altered lipid metabolism, thyroid hormonal imbalances, impaired fertility, renal dysfunction, increased prevalence of respiratory symptoms, asthma, cardiac arrhythmias, hypertension, musculoskeletal pain, injuries in up to 89% and skin disorders in up to 87.5-100% of e-waste workers. Due to inconsistent findings, weak associations or poor study quality, it has rarely been possible to establish a causal relationship between informal e-waste work and health effects, except for injuries or skin conditions. Besides high-quality studies, a collective national and international political focus on e-waste disposal is needed.

Implementing a Needs Assessment to Advance Health Equity in Overdose Prevention and Surveillance Initiatives.

State, local, and federal agencies have expanded efforts to address the root causes of overdoses, including health inequity and related social determinants of health. As an Overdose Data to Action (OD2A) technical assistance provider, the Association of State and Territorial Health Officials (ASTHO) conducted the first national needs assessment to understand capacity and technical assistance needs of OD2A jurisdictions in advancing health equity. ASTHO designed and disseminated the OD2A Recipient Health Equity Needs Assessment (RHENA) to 66 OD2A-funded jurisdictions from February to March 2022. OD2A principal investigators and staff were contacted via email and asked to complete the needs assessment within 6 weeks. One coder manually coded open-ended responses, conducted a thematic analysis on the qualitative data, and performed a simple frequency analysis on the quantitative data. Fifty-two jurisdictions (78.8%) responded, including 36 states, 12 cities/counties, and 2 territories. Most jurisdictions (n = 46; 88.5%) reported having a formal or informal health equity lead in place. Common barriers included a lack of access to data sources (n = 37; 71.2%), lack of partnerships (n = 20; 38.5%), and lack of funding (n = 14; 26.9%). Respondents reported needing more information sharing among jurisdictions and partner organizations, coaching on best practices, and routine discussions such as peer-to-peer learning sessions. Findings suggest that gaps remain in programmatic policies and principles to address inequities in overdose prevention. Results are being used to identify additional technical assistance opportunities, jurisdictional capacity, and approaches to advance health equity.

Using expressive writing to improve cancer caregiver and patient health: A randomized controlled feasibility trial

PurposeThis study examined the feasibility and preliminary efficacy of Expressive Writing (EW) in improving informal cancer caregiver (IC) and patient health, and enhancing ICs’ emotion regulation. MethodFifty-eight breast cancer ICs and patients participated in a randomized controlled feasibility trial of remote EW. ICs were randomly assigned to the EW or control group and completed 3 weekly writing sessions. ICs and patients completed health and emotion regulation assessments at baseline, intervention completion, and 3 months post-intervention. Screening, recruitment, assessment process, randomization, retention, treatment adherence, and treatment fidelity were computed for feasibility. Effect sizes were calculated using the PROMIS Depression Short Form, RAND Short Form 36 Health Survey, Breast Cancer Prevention Trial Hormonal Symptom checklist, healthcare utilization, and the Emotion Regulation Questionnaire for efficacy. ResultsOf the 232 interested individuals, 82 were screened, and 60 enrolled (6 monthly). Two individuals withdrew and 19 were lost to follow-up, leaving 39 individuals. ICs completed at least one assessment and two sessions, and patients completed at least two assessments. All sessions were administered as intended. ICs generally followed instructions (88%–100%), wrote the full time (66.7%–100%), and were engaged (M(SD) = 3.00(1.29)-4.00(0.00)). EW had small-to-medium effects in improving IC health (g = −0.27–0.04) and small-to-large effects in improving patient health (g = −0.28-0.86). EW moderately decreased suppression (g = 0.53–0.54) and slightly increased reappraisal, at least 3 months post-intervention (g = −0.34-0.20). ConclusionsRemote EW may be feasible with cancer ICs and improve cancer IC and patient health. However, it can benefit from additional retention strategies and rigorous testing.Trial registration: CenterWatch Clinical Trials Listing Service (#TX217874); ClinicalTrials.gov (#NCT06123416).

Willingness-To-Pay for Health Insurance: Protocol for a Comparative Study Between Formal and Informal Health-Workers

INTRODUCTION People in low- to middle-income countries (LMICs), such as Bangladesh, have less access to healthcare than those in wealthier nations with less than 1% of the population having access to social health protection, which is mostly limited to those who work in the formal sector (14.9% of all jobs). This comparative study aims to use the contingent valuation method (CVM) to determine the factors affection and compare the mean willingness-to-pay (WTP) for community-based health insurance (CBHI) between formal and informal health workers. METHODS AND ANALYSIS This comparative study will be conducted among 250 doctors who will be selected by a convenience sampling technique from various formal and informal workstations in Dhaka City. Of the 250 participants, 125 will be from each group. To collect data, a semi-structured questionnaire will be used via face-to-face interviews. Data will be processed and analyzed using R (v4.3.0) and RStudio (v2023.03.1). WTP for CBHI will be estimated using the “DCchoice” package. The primary outcome is to estimate the proportion and mean WTP across the groups and compare it using double bound dichotomous choice (DBDC) method. Secondary outcomes include identifying the socio-demographic, job-related and healthcare seeking-related factors that influence the WTP. ETHICS AND DISSEMINATION Ethics approval has been obtained from Institutional Review Board (IRB) of the National Institute of Preventive and Social Medicine (NIPSOM). Informed consent will be taken from each participant before data collection. The results of the study will be published in scientific, peer-reviewed journals. STRENGTHS AND LIMITATIONS OF THIS STUDY – The contingent valuation method is a well-established method of eliciting WTP for health insurance. – The current study will be among the first of its nature as it will focus on formal and informal healthcare workers. – Starting point bias may affect the result as this type of bias comes with the Double bounded dichotomous choice (DBDC) method used in this study.

Understanding the interplay of occupational, public health, and climate-related risks for informal workers: A new framework with findings from Zimbabwe and India

Globally, there are 2 billion ‘informal’ workers, who lack access to social protection while facing profound health risks and socioeconomic exclusions. The informal economy has generated most jobs in Low and Middle-Income Countries (LMICs), but few studies have explored informal workers' complex health vulnerabilities, including in the face of climate change.This paper will discuss recent action-research in Indore (India), Harare, and Masvingo (Zimbabwe) with informal workers like vendors, waste-pickers, and urban farmers. We conducted qualitative interviews (N = 110 in India), focus group discussions (N = 207 in Zimbabwe), and a quantitative survey (N = 418 in Zimbabwe). Many informal workers live in informal settlements (‘slums’), and we highlight the interrelated health risks at their homes and workplaces. We explore how climate-related threats—including heatwaves, drought, and floods—negatively affect informal workers' health and livelihoods. These challenges often have gender-inequitable impacts. We also analyse workers' individual and collective responses.We propose a comprehensive framework to reveal the drivers of health in the informal economy, and we complement this holistic approach with a new research agenda. Our framework highlights the socioeconomic, environmental, and political determinants of informal workers' health. We argue that informal workers may face difficult trade-offs, due to competing priorities in the face of climate change and other risks. Future interventions will need to recognise informal workers’ array of risks and co-develop multifaceted solutions, thereby helping to avoid such impossible choices. We recommend holistic initiatives to foster health and climate resilience, as well as participatory action-research partnerships and qualitative, intersectional data-collection with informal workers.

Informal health sector and routine immunization: making the case for harnessing the potentials of patent medicine vendors for the big catch-up to reduce zero-dose children in sub-Saharan Africa.

The COVID-19 pandemic caused a surge in the number of unimmunized and under-immunized children in Africa. The majority of unimmunized (or zero-dose) children live in hard-to-reach rural areas, urban slums, and communities affected by conflict where health facilities are usually unavailable or difficult to access. In these settings, people mostly rely on the informal health sector for essential health services. Therefore, to reduce zero-dose children, it is critical to expand immunization services beyond health facilities to the informal health sector to meet the immunization needs of children in underserved places. In this perspective article, we propose a framework for the expansion of immunization services through the informal health sector as one of the pillars for the big catch-up plan to improve coverage and equity. In African countries like Nigeria, Ethiopia, Tanzania, and the Democratic Republic of Congo, patent medicine vendors serve as an important informal health sector provider group, and thus, they can be engaged to provide immunization services. A hub-and-spoke model can be used to integrate patent medicine vendors into the immunization system. A hub-and-spoke model is a framework for organization design where services that are provided by a central facility (hub) are complimented by secondary sites (spokes) to optimize access to care. Systems thinking approach should guide the design, implementation, and evaluation of this model.

Informal welders' occupational safety and environmental health risks in northwestern Tanzania.

Often with minimal formal training and protections, informal welders face significant occupational health and safety (OSH) risks. This cross-sectional study of 219 adult informal welders at 70 informal welding sites in Mwanza City, Tanzania aimed to: 1) capture knowledge and awareness of occupational risks and safety precautions, training, and self-reported work-related injuries and illness and 2) observe worker use of personal protective equipment and site safety. We hypothesized that knowledge, awareness, and site inspections would improve use of PPE and that improved safety and site inspections would reduce self-reported injuries and illness. A generalized linear model (GLM) was used to model all relationships. Robust standard error estimation was used to avoid overestimation of parameters. Having a post-secondary education (aβ = 1.01, 95% CI: 0.962, 1.061; p = 0. 0679), having training in OSH (aβ = 0.927, 95% CI: 0.872, 0.984, p = 0.014), increased knowledge of occupational risks (aβ = 1.305, 95% CI: 1.143, 1.491; p<0.001), and knowledge of safety measures (aβ = 1.112, 95% CI: 0.881, 1.404; p = 0.372) increased PPE use by 1%, 7.3%, 30.5%, and 11.2% respectively. Workers who used PPE were less likely to experience fire explosions (AOR = 0.149, 95% CI: 0.029, 0.751; p = 0.02), radiation exposure (AOR = 0.097, 95% CI: 0.016, 0.579, p = 0.01) or electric shocks (AOR = 0.012; 95% CI: 0.001, 0.11, p<0.001). Having increased knowledge of safety practices also decreased the odds of fire explosions (AOR = 0.075, 95% CI: 0.018, 0.314; p<0.001). Those with higher knowledge of occupational risk (aβ = 1.57, 95% CI: 1.404, 1.756; p<0.001) and safety measures (aβ = 1.628, 95% CI: 1.34, 1.978; p<0.001) were more likely to have more positive attitudes towards safety practices. Our findings suggest that comprehensive targeted interventions including increased knowledge of occupational risks, safety practices, and occupational health law through training, along with enforcement and inspection by government officials, would benefit the environmental and occupational health for informal welders.

Caregiver burden and health-related quality of life: A study of informal caregivers of older adults in Ghana.

Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghanato date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship between caregiver burden and HRQoL among informal caregivers of older adults in Ghana. We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50years)inthe Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was usedto measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of 0.05 or less. The mean age of the informal caregivers was 39.15years and that of the care recipients was 75.08years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (β = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants withno formal education (β = -1.204, SE=.4085, p value =0.01), those withprimary level of education (β = -2.390, SE=.5099, p value =0.001) orjunior high school education (β = -1.113, SE=.3903, p value= 0.01) hada significantly decreased HRQoLcompared to those with tertiary level of education. Participants who werebetween the ages of 18-24 (β = 2.960, SE=.6306, p value=0.001), 25-34 (β = 1.728, SE=.5794, p value=0.01) or 35-44 (β = 1.604, SE=.5764, p value= 0.01) years significantly had increased HRQoLcompared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the pastyear before the survey significantly had increased HRQoLcompared to those who utilized healthcare services five or more times in the pastyear (β = 4.786, SE=. 4610, p value=0.001). Consistent with our hypothesis, this study reported asignificant negativeassociation between caregiver burden and HRQoL. Our findings partially support the conceptual model of HRQoLused in this study. We recommend that health and social policy measures to improve HRQoL among informal caregivers of older adultsshould consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors.

Reproductive health service access and utilisation among migrant women in Dhaka’s urban slums: a qualitative study

This study explores the impact of migration on the access and utilisation of sexual and reproductive health services by women living in an informal settlement in Dhaka, Bangladesh. A total of 16 in-depth interviews were conducted in March and April of 2019 with women (18–49 years old) who had migrated from rural areas to Dhaka. They reported continued economic insecurity while receiving minimal support from the state. All women reported financial and infrastructural barriers to accessing formal sexual and reproductive health services and tended to seek resources and support through social networks within the slum and from informal health services. Compared with more recent migrants, women who had migrated and resided in the slums for longer found it easier to utilise social networks and resources for sexual and reproductive health. Women had more agency in experimenting with contraceptives but had less power in making decisions during pregnancy and when seeking health care. Menstrual health was a neglected aspect of public health. The study indicates that public health policy targeting the urban poor needs to address the unique challenges faced by migrant women in informal settlements to rectify inequities in health services that leave significant portions of the urban poor population behind.

Service providers' perspectives on the challenges of informal caregiving and the need for caregiver-orientated mental health services in rural South Africa: A descriptive study.

Informal caregivers of persons with mental disorders encounter various challenges in their role of caregiving. As such, they require support to enable them to cope with the demands of their caregiving. There is comprehensive evidence on the experiences of burden among informal caregivers in mental health; however, there is a limited number of studies that report on the mental health services aimed specifically at supporting informal caregivers in their role. To address this gap, this study aimed to explore the perspectives of the service providers regarding the challenges encountered by informal caregivers and the mental health services available to support these caregivers. Semi-structured interviews were conducted with mental health coordinators at provincial, district, and sub-district level and mental health professionals from a district hospital. Focus group discussions were conducted with primary healthcare supervisors and community health workers in Bushbuckridge municipality, South Africa at participants' workplaces and sub-district offices. Semi-structured interviews and focus group guides with semi-structured questions were used to direct data collection in August 2022-January 2023. All interviews were audio recorded and transcribed verbatim. Reflexive thematic inductive analysis was conducted using NVivo 12 software. Three themes were identified, namely perceived caregiving consequences and related factors, current state of mental health services, and factors affecting delivery of informal caregiver mental health services. The service providers acknowledged the negative consequences faced by informal caregivers. This includes the experience of caregiver burden which was attributed to the uncooperative and violent behaviours exhibited by the mental health care users. The current state of formal and informal community mental health services was described and considered inadequate to meet informal caregivers' needs. Various personal, health system, and contextual factors influencing the provision of caregiver-orientated services were identified. The findings revealed the need for intersectoral collaborations between hospital-based and community-based mental health service providers, and community stakeholders to ensure provision of user-friendly and accessible mental health services for informal caregivers.

Evaluating mental health awareness and attitudes among international students in Japan during the COVID-19 pandemic

ObjectivesInternational students in Japan face unique mental health challenges stemming from cultural and linguistic differences, potentially accentuated by the COVID-19 pandemic. However, research on the mental health of this demographic is scarce. This study aims to describe their mental health status, awareness of mental health resources, and attitudes toward seeking mental health support. MethodsThis study conducted analyses based on data collected though an online survey at a national university in Japan during October and November 2022. International students were surveyed about their mental health status, awareness, and attitude. Descriptive statistics and Chi-square tests were employed to examine the associations between survey responses and demographic variables. ResultsAmong the 116 surveyed participants, 6.9% reported experiencing poor mental health, 16.4% rated their mental health as fair, and 1.7% expressed uncertainly about their mental health status. Similarly, 4.3% indicated poor physical health, 21.6% rated their physical health as fair, and 0.9% expressed uncertainty about their physical health. Additionally, 16.4% felt that their mental health adversely affected their daily life and academics, and 12.1% believed that their physical health had a similar negative impact. Awareness of mental health resources was notably low, with only 25.9% of students being informed. Furthermore, limited awareness was observed among older students (χ2 = 8.176, p < 0.01), degree-seeking students (χ2 = 4.727, p < 0.05), and those from African countries (χ2 = 4.721, p < 0.05), compared to their counterparts. A total of 10.4% expressed reluctance to pursue informal mental health support, and 9.5% showed similar reservations about seeking formal support. ConclusionThe study underscores the critical need for targeted outreach and the development of accessible, culturally sensitive mental health interventions for international students in Japan. Enhancing awareness and accessibility of mental health resources can contribute to the wellbeing of this demographic, potentially improving academic outcomes and fostering a more inclusive, supportive environment for international students, thereby advancing international collaboration and understanding.

Place-based, intersectional variation in caregiving patterns and health outcomes among informal caregivers in the United States.

Informal caregiving is a critical component of the healthcare system despite numerous impacts on informal caregivers' health and well-being. Racial and gender disparities in caregiving duties and health outcomes are well documented. Place-based factors, such as neighborhood conditions and rural-urban status, are increasingly being recognized as promoting and moderating health disparities. However, the potential for place-based factors to interact with racial and gender disparities as they relate to caregiving attributes jointly and differentially is not well established. Therefore, the primary objective of this study was to jointly assess the variability in caregiver health and aspects of the caregiving experience by race/ethnicity, sex, and rural-urban status. The study is a secondary analysis of data from the 2021 and 2022 Behavioral Risk Factor Surveillance System (BRFSS) from the Centers for Disease Control and Prevention. Multivariable logistic regression or Poisson regression models assessed differences in caregiver attributes and health measures by demographic group categorized by race/ethnicity, sex, and rural-urban status. Respondents from rural counties were significantly more likely to report poor or fair health (23.2% vs. 18.5%), have obesity (41.5% vs. 37.1%), and have a higher average number of comorbidities than urban caregivers. Overall, rural Black male caregivers were 43% more likely to report poor or fair health than White male caregivers (OR 1.43, 95% CI 1.21, 1.69). Urban female caregivers across all racial groups had a significantly higher likelihood of providing care to someone with Alzheimer's disease than rural White males (p < 0.001). Additionally, there were nuanced patterns of caregiving attributes across race/ethnicity*sex*rural-urban status subgroups, particularly concerning caregiving intensity and length of caregiving. Study findings emphasize the need to develop and implement tailored approaches to mitigate caregiver burden and address the nuanced needs of a diverse population of caregivers.

THE ROLES OF INFORMAL COMMUNITY-BASED HEALTH WORKERS IN GLOBAL HIV/AIDS EPIDEMIC CONTROL TARGETS BY 2030 IN NIGERIA

Background Various categories of informal community-based health workers (CBHWs) across sub-Saharan Africa carry out different functions to address HIV/AIDS including support of the patients and families and support of the health system. A cross-sectional survey was conducted to investigate and document the characteristics and the specific roles of informal CBHWs in Nigeria's pursuit of the HIV/AIDS epidemic control targets of 95-95-95 by 2030. A total of 642 CBHWs were identified and interviewed in four Local Government Areas in Akwa Ibom and Cross River States.

Depression and help-seeking behaviors among college students: Findings from the Healthy Minds Study 2018-2019

Objective To determine the likelihood of using formal and informal mental health services among college students according to prior history of depression diagnosis and presence of depression symptoms. Participants College students from 79 universities in the U.S. and Canada who participated in the Healthy Minds Study, 2018-2019. Methods Odds ratios and 95% confidence intervals via logistic regression were estimated for the likelihood of using informal and formal mental health services stratified by depression diagnosis and severity of depression symptoms and further stratified by race/ethnicity. Results We report increased odds of using formal mental health services with increasing depression severity symptoms and increased odds of using formal mental health services among students without a clinical depression diagnosis. The odds of service utilization varied by race/ethnicity. Conclusions The likelihood of seeking mental health services differs depending on the history of formal depression diagnosis, current symptoms, and race/ethnicity among college students.

Exploring cultural differences in the understanding of Alzheimer’s Disease and related dementias among Alaska Natives and providers in Alaska

AbstractBackgroundThe proportion of the Native population aged 65+ is projected to increase between 2015 and 2045, from 7‐12%, and informal caregivers and health care providers are ill‐prepared to meet the demand of Alzheimer’s Disease and related disorders (ADRD). There is an increasing urgency to better understand Alaska Native views of ADRD.MethodGuided by Kleinman’s explanatory model of illness, a qualitative, research design was utilized to gather data on experiences with ADRD. 21 interviews with Alaska Native caregivers and 12 interviews with health care providers in rural and urban communities were completed. Using Nvivo qualitative software, thematic analysis was used to obtain cultural perspectives on ADRD. This study was approved by the University and tribal review boards.ResultMany Alaska Natives view ADRD as a natural part of the aging process, resulting in not always seeking medical care. Caregivers challenges included family denial, exhaustion and isolation, and family distancing themselves due to fear and limited understanding of ADRD. Caregiving benefits included spending time with older adult, learning family history, and sharing experiences with other caregivers. Healthcare provider challenges included rigidity of the healthcare system, no research on Alaska Natives, limited health literacy, limited community resources, and no knowledge of Alaska Native views of ADRD.ConclusionUnderstanding the cultural underpinnings of ADRD provides insight into how health care providers can integrate cultural beliefs into treatment to improve the processes of care that may mitigate the impact of ADRD on individuals and families. Culturally‐responsive education and training about ADRD is crucial to connecting Alaska Natives with ADRD to care that can assist them in aging more comfortably

Addressing Antimicrobial Resistance (AMR) on Dairy Farms: A One Health Case Study from Punjab, India

Abstract This case study explores the antimicrobial usage (AMU) practices on Punjab’s dairy farms, aiming to address the challenge of antimicrobial resistance (AMR) through collaborative efforts. It uncovers diverse AMU practices contributing to misuse, particularly on farm management-related diseases, such as mastitis, reproductive disorders, diarrhoeal diseases, and blood parasite infections. Some animal farms displayed high AMU levels of ‘critical importance’ category antibiotics, as per the World Health Organization. Additionally, some farmers exhibited inadequate knowledge and understanding of the importance of completing adequate antimicrobial therapy courses. The key risk factors for incorrect AMU include lack of awareness among the informal animal health service providers (without formal education/qualification), over-the-counter access of antibiotics, self-treatment practices by the farmers, and limited understanding of AMR’s public health implications. The study undertook a series of initiatives to combat AMR, including subject awareness workshops, biosecurity awareness activities comprising proper disposal of farm waste, and workshops for veterinarians, para-veterinarians, and farmers, sensitizing about AMR’s adverse consequences. Recommendations include enhancing access to qualified veterinarians, discouraging reliance on unauthorized practitioners, enhancing diagnostic capabilities, and providing technical support for disease prevention. Establishing AMU and AMR surveillance systems is essential for informed decision-making. Collaborative efforts are vital to raise awareness, promote responsible AMU, and ensure animal and public health security. These joint actions among dairy chain stakeholders are imperative to combat AMR and foster sustainable dairy production while protecting animal and human health. Information © The Authors 2023