Involving Healthcare Providers Research Articles

Assessment of women’s needs and wishes regarding interprofessional guidance on oral health in pregnancy – a qualitative study

BackgroundPoor oral and dental health due to oral dysbiosis during pregnancy increases the risk for negative pregnancy outcomes. Communicating the importance of oral health is therefore essential in reducing the risk of adverse pregnancy outcomes. Professional guidance could substantially support women’s positive perception of their own competence. Information on oral health should be provided by healthcare professionals such as midwives, obstetricians and dentists. The aim of this study was to assess the needs, wishes and preferences of pregnant women in Germany, regarding interprofessional collaboration and guidance on oral health during pregnancy.MethodsSources of information, preferences regarding information supply as well as the need for interprofessional collaboration of involved healthcare professions were investigated in six online focus groups with pregnant women. In addition, three expert interviews with a midwife, an obstetrician and a dentist were conducted. The focus groups and interviews were analysed using qualitative content analysis according to Kuckartz.Results25 pregnant women participated in focus groups. Pregnant women in all trimesters, aged 23 to 38 years, were included. Many women did not receive any or received insufficient information on oral health during pregnancy and wished for more consistent and written information from all involved healthcare providers. The extent of oral health counselling women received, heavily relied on their personal initiative and many would have appreciated learning about the scientific connection between oral health and pregnancy outcomes. An overall uncertainty about the timing and safety of a dental visit during pregnancy was identified. Interviews with experts provided additional insights into the working conditions of the involved healthcare professionals in counselling and emphasised the need for improved training on oral health during pregnancy in their respective professional education as well as thematic billing options in relation to this topic.ConclusionGuidance of women on oral health during pregnancy appears to be insufficient. Providing information adapted to the needs, wishes and preferences of women during pregnancy as well as the implementation of this topic in the education of involved healthcare professionals could contribute to an improved prenatal care for pregnant women and subsequently a reduced risk of negative pregnancy outcomes.

A Method for Ocular Disease Diagnosis through Visual Prediction Explainability

Ocular diseases can range in severity, with some being more serious than others. As a matter of fact, there are several common and severe eye diseases, for instance, glaucoma, i.e., a group of eye conditions that damage the optic nerve, often associated with elevated intraocular pressure. Effective management and prevention strategies require a multifaceted approach, involving healthcare providers, public health officials and community education. Regular screenings and early interventions are crucial in reducing the impact of eye diseases on individuals and populations. In this paper, we propose a method aimed to detect the presence of ocular disease from the automatic analysis of eye fundus photographs. We consider deep learning; in detail, we adopt several convolutional neural networks aimed to train several models to be able to discriminate between different eye diseases. Furthermore, to boost the application of deep learning in real-world everyday medical practice, we adopt a method to understand which areas of the images are of interest from the model’s point of view; this allows us to detect disease by providing in this way disease localization by explainability. In the experimental analysis, we provide a set of four different experiments: in the first one, we propose a model to discern between age-related macular degenerations and normal fundus (obtaining an accuracy of 0.91); in the second one, the model is able to discriminate between cataract and normal fundus (obtaining an accuracy of 0.92); the third experiment is related to a model aimed to discriminate between glaucoma and normal ocular fundus (obtaining an accuracy of 0.88); and the last experiment is related to a model aimed to discern between pathological myopia and normal ocular fundus (obtaining an accuracy of 0.95). Thus, the experimental analysis confirms the effectiveness of the proposed method from a quantitative point of view (analysis aimed at understanding whether the model is able to correctly identify the disease) but also from a qualitative one, with a detailed and reasoned analysis aimed at understanding whether the model is able to correctly localize the disease.

Perinatally Acquired HIV: Viral Evolution and its Implications for Adolescents

This literature review explores the implications of viral evolution on the health outcomes of adolescents with perinatally acquired HIV, offering recommendations for enhancing public health practices. Since the emergence of HIV in the 1980s, perinatal transmission from parent to child has become increasingly prevalent in developing countries. Antiretroviral therapy (ART) has greatly improved the life expectancy of children with perinatally acquired HIV, allowing them to reach adolescence. ART plays a critical role in suppressing HIV and reducing the risk of transmission. Nevertheless, low adherence or lack of treatment can lead to viral evolution and drug resistance, posing significant threats to adolescents. Challenges faced by adolescents with perinatally acquired HIV are multifaceted, including increased viral evolution and difficulties in adhering to ART. The impact of stigma, behavioral factors, and social and familial dynamics contribute to low adherence rates. Global inequities and systems-level challenges further complicate the situation, particularly in resource-limited settings. Adequate public health infrastructure and innovative approaches, such as long-acting injectable ART, are imperative to address these structural barriers and reduce drug resistance among adolescents. Comprehensive data collection and longitudinal studies are needed to understand the long-term consequences of perinatally acquired HIV and its impact on viral evolution. A multidisciplinary approach involving healthcare providers, virologists, and social scientists is crucial to meeting global HIV goals and addressing the specific needs of this vulnerable population.

Sickle Cell Anemia – A Societal and Clinical Challenge in a Wardha City

Sickle cell anemia is a hereditary blood disorder that poses significant clinical and societal challenges, predominantly affecting individuals globally. Clinically, it is marked by severe pain episodes, organ damage, heightened infection risk, and limited treatment options. These complications necessitate comprehensive, ongoing medical care. Societal challenges include healthcare disparities, stigma, psychosocial impacts, and barriers to education and employment. Addressing these issues in Wardha city requires improving access to specialized care, enhancing public awareness, investing in research for new treatments, and providing robust support systems for patients and caregivers. A multifaceted approach involving healthcare providers, researchers, policymakers, and communities is essential to effectively manage and mitigate the impacts of this debilitating disease..

Sickle Cell Anemia – A Societal and Clinical Challenge in a Wardha City

Sickle cell anemia is a hereditary blood disorder that poses significant clinical and societal challenges, predominantly affecting individuals globally. Clinically, it is marked by severe pain episodes, organ damage, heightened infection risk, and limited treatment options. These complications necessitate comprehensive, ongoing medical care. Societal challenges include healthcare disparities, stigma, psychosocial impacts, and barriers to education and employment. Addressing these issues in Wardha city requires improving access to specialized care, enhancing public awareness, investing in research for new treatments, and providing robust support systems for patients and caregivers. A multifaceted approach involving healthcare providers, researchers, policymakers, and communities is essential to effectively manage and mitigate the impacts of this debilitating disease..

Barriers and facilitators to screen for and address social needs in primary care practices in Maryland: a qualitative study

BackgroundSocial needs screening can help modify care delivery to meet patient needs and address non-medical barriers to optimal health. However, there is a need to understand how factors that exist at multiple levels of the healthcare ecosystem influence the collection of these data in primary care settings.MethodsWe conducted 20 semi-structured interviews involving healthcare providers and primary care clinic staff who represented 16 primary care practices. Interviews focused on barriers and facilitators to awareness of and assistance for patients' social needs in primary care settings in Maryland. The interviews were coded to abstract themes highlighting barriers and facilitators to conducting social needs screening. The themes were organized through an inductive approach using the socio-ecological model delineating individual-, clinic-, and system-level barriers and facilitators to identifying and addressing patients' social needs.ResultsWe identified several individual barriers to awareness, including patient stigma about verbalizing social needs, provider frustration at eliciting needs they were unable to address, and provider unfamiliarity with community-based resources to address social needs. Clinic-level barriers to awareness included limited appointment times and connecting patients to appropriate community-based organizations. System-level barriers to awareness included navigating documentation challenges on the electronic health record.ConclusionsOvercoming barriers to effective screening for social needs in primary care requires not only practice- and provider-level process change but also an alignment of community resources and advocacy of policies to redistribute community assets to address social needs.

The Vital Role of Pharmacists in Diabetes Self-care

The number of people affected by diabetes is projected to rise significantly by 2030. As of 2021, 537 million people were living with diabetes with the numbers projected to rise to 643 million by 2030. The growing number of patients living with diabetes means that the demand for care will likely go up. Healthcare providers provide diabetes care more so the regular follow-up required by patients living with the disease. They also work together with the patients in facilitating self-care. Diabetes self-care is instrumental for patients living with diabetes. It ensures patients achieve glycemic control and have a lower risk of having complications. However, for most patients, practicing self-care can be a challenge. Most lack the knowledge and skills that are required to practice self-care confidently. Involving healthcare providers in diabetes self-care can lead to better disease outcomes. Pharmacists can provide the regular follow-ups and other services that lead to effective self-care such as health literacy. Pharmacists-led diabetes management interventions have been shown to lead to good outcomes including better glycemic control and reduced likelihood of having high blood pressure. Therefore, the aim of this review is to explore the role of pharmacists in diabetes self-care. Keywords: diabetes, diabetes self-care, diabetes complications, pharmacists, glycemic control

Awareness of Gestational Diabetes Mellitus Maternal and Neonatal Outcomes Among Women Attending Primary Healthcare Centers in Qassim, Saudi Arabia.

Background Gestational diabetes mellitus (GDM), diagnosed during pregnancy, can harm both mothers and neonates. GDM awareness among women varies among various countries. Understanding the level of awareness is vital for designing effective health interventions. Objectives This study aimed to evaluate GDM awareness among married females at primary healthcare centers (PHCCs) in Qassim, Saudi Arabia, focusing on knowledge regarding adverse maternal and fetal outcomes of GDM. Methods An observational cross-sectional study was conducted among married females at PHCCs in Qassim, from June 2023 to October 2023. A two-stage cluster sampling method was used. Four PHCCs were selected in the first stage, and study participants were selected from these centers in the second stage. A self-administered questionnaire was used. Statistical Product and Service Solutions (SPSS, version 23;IBM SPSS Statistics for Windows, Armonk, NY) was used for statistical analysis. Results Of the 270 participants, the majority (72.2%) demonstrated 'poor' knowledge about GDM adverse outcomes for both mothers and neonates, 17.8% demonstrated a 'fair' level, and only 10% displayed a 'good' knowledge. Participants' educational level, personal history of diabetes, and age were associated with knowledge levels. Awareness of specific outcomes related to GDM, both maternal and neonatal, varied among participants. Information on GDM was mainly obtained from mass media and personal networks, while healthcare providers were reported as the least common source. Conclusion Based on the results of our study, weconclude that educational interventions, especially involving healthcare providers, are essential to improve awareness about GDM adverse outcomes. Strategies involving educational sessions by healthcare providers and health education materials at PHCCs can improve awareness leading to effective management of GDM and improved maternal and neonatal outcomes.

Postpartumzorg in de eerste lijn: samenvatting van een multidisciplinaire richtlijn (deel 1)

Postpartum care in primary care: summary of a multidisciplinary guideline The lying time at the maternity ward for a healthy woman giving birth to a healthy baby is now on average less than 3 days. Therefore, primary care providers have a greater responsibility in the follow-up of the mother and newborn during the postpartum period. This article is a summary of the first part of the multidisciplinary guideline Postpartum care in primary care developed by the national Working Group Development of Primary Care Guidelines (WOREL) according to the internationally recognised methods of guideline development. The guideline formulates recommendations for quality postpartum care in collaboration with all involved healthcare providers with the aim of recognising and addressing complications in the newborn and mother in a timely manner. It is important that healthcare providers know what is normal, which red flags they should not miss, have basic knowledge about conditions and situations, and timely refer the patient to primary or secondary care. The article describes what attitude to adopt in case of life-threatening and serious complications in the maternity woman (postpartum haemorrhage, pre-eclampsia, venous thromboembolism and endometritis) and the newborn (jaundice, neonatal sepsis, congenital heart defect, dehydration, nutritional difficulties and metabolic disorders), as well as in case of less severe complications or complaints in the maternity woman (perineal pain, headache, constipation, haemorrhoids, urinary incontinence, fatigue and back pain) and the baby (gastro-oesophageal reflux, thrush, nappy dermatitis, intestinal cramps, conjunctivitis, cord infections and fever). Finally, specific situations in both the mother (prevention of antibody formation, rubella vaccination, thyroid disorders and gestational diabetes) and the newborn (cord care, prevention of sudden death, vitamin K and vitamin D substitution, and child abuse) are highlighted.

Exploring the barriers to mental health service utilization in the Bolgatanga Municipality: the perspectives of family caregivers, service providers, and mental health administrators

BackgroundMental health service utilization remains a challenge in developing countries, with numerous barriers affecting access to care. Albeit data suggest poor utilization of mental health services in the Bolgatanga Municipality in Ghana, no studies have explored the barriers to the utilization of mental health services. Therefore, this study explored the perspectives of family caregivers, service providers, and mental health service administrators on the barriers to mental health service utilization in the Bolgatanga Municipality, Ghana.MethodsA qualitative descriptive design was employed for the study. Nineteen participants were purposively sampled from two hospitals including fifteen family caregivers, two service providers, and two mental health administrators. Data were collected through individual in-depth interviews using a semi-structured interview guide. Audio-recorded interviews were transcribed verbatim and thematically analyzed using NVivo 12 pro software.ResultsFive main themes emerged including individual-level barriers, interpersonal barriers, community-level barriers, organizational-level barriers, and policy-level barriers. At the individual level, lack of insight, poor treatment compliance, and financial challenges were prominent barriers. Interpersonal barriers included family pressure influenced by cultural and spiritual beliefs. At the community level, stigma and mental health illiteracy were identified as significant barriers. At the organizational level, barriers encompassed inadequate staffing, limited space, and staff attitudes. Policy-level barriers included the neglect of mental health in policies and the non-inclusion of mental health services in the National Health Insurance Scheme.ConclusionThis study highlights the complexity of barriers to mental health service utilization and underscores the need for a comprehensive approach to address them. Collaborative efforts involving healthcare providers, policymakers, communities, and families are essential to mitigate these barriers. It is imperative to consider these barriers when developing strategies to improve the utilization of mental health services in Ghana.

Food Insecurity and Health Inequities in Food Allergy.

The intersection of food insecurity among those with food allergy is a growing public health concern. Both food allergy and food insecurity have profound implications on health, social, and economic outcomes. The interaction of social determinants of health, poverty, racism, housing insecurity, and access to care has direct impact on individuals with food allergy. There is increasing evidence that universal screening for food insecurity is vital in the routine care of patients with food allergy. Individuals with food allergy who are also burdened by food insecurity face unique challenges related to the need to maintain dietary modifications often with expensive specialized diets, which are difficult to access. This may lead to limited dietary options, malnutrition, increased financial burden, and social isolation. While there are available resources and support systems that can assist individuals with food allergies in managing food insecurity, there is an increasing need for advocacy and inclusivity in policy frameworks involving multiple stakeholders. Multi-sector efforts involving healthcare providers and advocacy and government agencies are necessary to support policy changes that protect the rights and well-being of individuals affected by food allergy and food insecurity. By increasing awareness, improving access to safe, affordable, allergen-free food, and advocating for policy change, we can work toward ensuring universal access to safe, nutritious food for all individuals, regardless of their food allergy status or socioeconomic background.

Insomnia : Defination, Symptoms, Causes, Diagnosis, and Treatment

Insomnia is a complex sleep disorder influenced by medical conditions, psychological factors, lifestyle habits, and environmental influences. Effective management requires a comprehensive approach, including non-pharmacological interventions like CBT-I and lifestyle modifications. Pharmacological treatments may be considered for short-term relief, but should be used cautiously. A multidimensional approach involving healthcare providers, sleep specialists, and patients can improve sleep quality and overall well-being.

Evaluation of the General Population's Knowledge Concerning Liver Health: A Cross-Sectional Study.

Liver disease is among the leading causes of global mortality and morbidity. Given their substantial impact on public health, raising awareness about liver diseases is paramount for their prevention and effective management. This study aimed to evaluate the knowledge, awareness, attitudes, and behaviors of Syrians regarding liver health, chronic liver disorders, and their associated serious and irreversible complications. We conducted a cross-sectional study encompassing the adult Syrian population between August 25 and September 29, 2023, excluding non-Syrians and individuals below the age of 18 years. A validated questionnaire, adapted from a previous study, was employed, consisting of 31 questions that covered topics related to knowledge and awareness of liver health and diseases (3-point Likert scale), attitudes towards liver screening, diagnosis, and treatment, and awareness of treatment options and vaccination. Statistical analysis including logistic regression was conducted using Statistical Product and Service Solutions (SPSS, version 28; IBM SPSS Statistics for Windows, Armonk, NY), with statistical significance set established at pp-values below 0.05. This study included 941 participants, with an average age of 26.5 years. While two-thirds of respondents demonstrated awareness of hepatitis B and C as viral diseases (663 (70.4%) and 612 (65.4%), respectively), approximately 66 (7%) were unaware of the potential for hepatitis to induce chronic liver inflammation or lead to liver failure. Over half of the participants were knowledgeable about the non-genetic nature of hepatitisB and C, and 579 (61.7%) were informed about the transmission risks associated with these infections. The most common reason cited for not participating in health screening tests was the perception of being in good health (219, 77.4%), and prescription medication was the most frequently sought treatment for hepatitis (543, 83.9%). Bivariate analysis revealed correlations between participant knowledge and sex, socioeconomic status, educational level, and occupation (P < 0.05). Similarly, the study identified significant associations between participant attitudes and age, gender, economic status, job, and educational level (P < 0.05). Moreover, the multivariate analysis demonstrated that gender, occupation, and educational level significantly influenced both participants' knowledge and attitudes. Specifically, males exhibited lower knowledge and less favorable attitudes than females (P = 0.041 and P < 0.001, respectively). The Syrian population possessed moderate knowledge of liver health and liver disorders. To bridge this knowledge gap and enhance preventive measures, it is recommended that additional health programs and awareness initiatives be implemented, involving healthcare providers and leveraging their expertise.

Integration of Psychosocial Theory into Palliative Care: Implications for Care Planning and Early Palliative Care.

Palliative care improves patients' symptoms, quality of life and family satisfaction with caregiving, reduces hospital admissions and promotes alignment of medical care with the patient's needs and goals. This article proposes the utility of integrating three psychosocial theories into standard palliative care with implications for care planning, early palliative care and optimizing quality of life. First, Control Theory focuses on the complex juxtaposition of promoting agency/empowerment in patients and carers and coping with often highly uncertain outcomes. Second, Optimal Matching Theory accounts for the alignment of need and provision of care to potentiate the quality of life effects of supportive care in a complex social process involving health care providers, patients and carers. Third, Hope Theory represents a dynamic process, which is marked by variation in the qualities of hope as the patient and carer confront challenges during palliative care. Future work will be translational in nature to adapt both assessment and interventions based on this theoretically driven augmentation of palliative care as well as to evaluate whether it provides a conceptual framework that has incremental utility in palliative care planning.

First case of MPox in Pakistan: What can we learn from it?

This research paper discusses Pakistan's healthcare systems' challenges in managing the monkeypox outbreak in Pakistan. Monkeypox is a zoonotic viral disease caused by the monkeypox virus. The World Health Organization declared it a global public health emergency due to the surge in cases worldwide. Pakistan reported its first verified case in April 2023, necessitating immediate response. This correspondence emphasizes on early detection, rapid diagnostic testing, and prompt treatment to limit the virus's transmission. Prevention strategies such as vaccination and travel restrictions on suspected cases are crucial for containment. Lessons from controlling the coronavirus disease 2019 pandemic can inform strategies for monkeypox. The recent outbreak of monkeypox has presented challenges to healthcare systems. Therefore, a coordinated approach involving healthcare providers, government organizations, and the public is crucial in controlling the monkeypox outbreak. Further research is necessary to understand the virus and develop effective interventions for future outbreaks.

The benefits of exclusive breastfeeding: a comprehensive literature review

This comprehensive literature review explores the multitude of benefits associated with exclusive breastfeeding for both infants and mothers. It synthesizes evidence from various studies and emphasizes the importance of exclusive breastfeeding as a global public health strategy. The review highlights the nutritional, immunological, developmental, and emotional advantages of exclusive breastfeeding for infants and mothers, including improved psychological well- being. Furthermore, it talks about the infant health benefits of exclusive breastfeeding, nutritional benefits, immune system support, optimal growth and development, and maternal benefits such as postpartum weight loss and uterine contraction and reduced health issues like breast cancer, ovarian cancer, etc. Additionally, societal implications such as reduced healthcare costs, environmental sustainability, and enhanced workforce productivity are discussed. Despite the clear benefits, challenges and barriers persist, including cultural norms, workplace pressures, and limited access to education and support. Strategies to promote and support exclusive breastfeeding involve healthcare providers, workplaces, communities, and global efforts by WHO and UNICEF, emphasizing the importance of creating a supportive environment for breastfeeding mothers.

The Impact of Providers as Health Discussants on Black Women's Interest in PrEP for HIV Prevention.

This study sought to examine the role of providers as health discussants (HD) on interest in preexposure prophylaxis for HIV prevention in a national sample of adult Black cisgender women (N = 315). Health discussant networks, a type of social network, may be influential in HIV prevention efforts. These networks, often composed of individuals' families, have improved health utilization outcomes in other disciplines. However, health discussants in HIV prevention are understudied, especially when considering providers as network members. We conducted a cross-sectional online survey and collected socio-demographic information, sexual history, HIV concerns, PrEP attitudes, healthcare utilization, mistrust, social support, and HD information. We used descriptive statistics and logistic regression to analyze data. Associations between PrEP interest and variables were examined. We found that older, partnered, who had recent healthcare visits or health insurance were more likely to involve healthcare providers as discussants. Anticipated PrEP stigma decreased provider involvement. Among participants listing providers as discussants, there was a greater likelihood of interest in using PrEP. Our findings indicate that healthcare provider support and social factors are crucial in promoting PrEP engagement among Black women. Integrating social dynamics and positive provider-patient interactions is essential for successful PrEP implementation.

Development and Implementation of an Integrated Pharmaceutical Care Program for patients with COPD in a Rehabilitation Hospital.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive disease associated with airflow limitation and prolonged respiratory problems. The treatment requires an interdisciplinary approach with a holistic view of the patient. A cornerstone of the treatment consists of inhalation therapy. Inhalation errors are abundant and medication adherence towards inhalation therapy is low. We aimed (1) to develop a standardized pharmaceutical care protocol for hospitalized patients with COPD and (2) to evaluate the effect and feasibility of protocol implementation.&#x0D; Methods: This study took place at the rehabilitation hospital Koningin Elisabeth Instituut (RH-KEI) in Oostduinkerke, Belgium from January 2021 to April 2022. The protocol was based on the PHARMACOP protocol, tailored to the specific setting using in-depth interviews with all HCPs involved in the pharmaceutical care of patients with COPD (physicians, pharmacists, pharmacy technicians, nurses, physiotherapists and an occupational therapist). The finalized protocol consisted of six additional patient contacts (3 evaluation moments, 2 educational moments and 1 evaluation moment two weeks after discharge), mainly between the hospital pharmacist and the patients. Consequently, from January 2022 to April 2022, adult patients with COPD were included to follow the complete protocol. Patient outcomes were evaluated using standardized questionnaires (i.e. mMRC, BMQ, CAT, EQ-D and EQ-VAS). The feasibility was assessed during a focus group discussion with all involved HCPs and a patient survey after discharge.&#x0D; Results: Before the start of the study, the hospital pharmacist in RH-KEI had no patient contact and there were no (recurrent) training sessions about inhaler use. The in-depth interviews elucidated that most involved health care providers (HCPs) had insufficient knowledge of the correct use of inhalers. This is however needed as 37% of included patients made at least one critical inhalation error at hospitalization. The adapted PHARMACOP protocol was tested in 13 patients, after which a significant improvement was noted in mMRC (p = 0.047), BMQ concerns (p = 0.011) and CAT score (p = 0.002). A trend towards improvement was noted in the EQ-5D and EQ-VAS score (resp. p = 0.065, p = 0.590). Finally, mean inhalation technique scores had significantly improved (p = 0.003). Transferring information to primary care HCPs seemed difficult as only a third of patients had handed over their discharge letter to their community pharmacist. The in-hospital HCPs concluded that the protocol was feasible for implementation with some adjustments, such as a more prominent role of the (hospital) pharmacist, the possibility to tailor the program to the patient and a set timing for interdisciplinary (patient) discussions. &#x0D; Conclusion: An interdisciplinary pharmaceutical care program can improve outcomes in patients with COPD. Additional attention should be given to the inclusion of primary care HCPs to guarantee continuity of care concerning inhalation therapy for COPD management.

Effective Targeting of Evolutions in Concerns Underpinning COVID Vaccine Hesitancy in Patients with Sickle Cell Disease across the Lifespan of the COVID19 Pandemic

COVID vaccine hesitancy among patients with sickle cell disease (SCD) was prevalent during the pandemic. This subset of vaccine hesitancy within the SCD population is of particular concern due to the elevated risk of severe illness associated with COVID-19 in individuals with SCD. Numerous factors contribute to vaccine hesitancy in this context, including concerns specific to SCD, such as potential interactions with disease-modifying therapies, uncertainty regarding vaccine efficacy in this population, mistrust in healthcare systems, and historical disparities in healthcare access and delivery. Underlying psychological factors, such as fear and anxiety, may also influence vaccine hesitancy in patients with SCD. We sought to survey our patients' feelings towards the COVID19 vaccination in the peak of the pandemic (Sept-Dec 2021), as we had noted that some patients had declined the offer of vaccination and others had had a one or two doses, then stopped. 54 patients with SCD were surveyed anonymously and data analysed in excel and NVivo. 27.8% had had no doses and only 14.8% had had the 3 doses as recommended at that time leaving 57.4% partially vaccinated. Breaking this down by age, the younger patients (&amp;lt;16y) were more likely to have had no doses (0%) with progressive rise in uptake to the older age group (&amp;gt;35) where 13.9% had had no doses. Even in this older age group, only 19.4% were fully vaccinated however (A). Qualitative analysis of text responses (B) revealed themes of concern regarding: Lack of trust in the new and ‘untested’ vaccine:Fear of side effects and complications, particularly concerns about the vaccine's compatibility with their conditions and medications.Mistrust in the vaccine's efficacy and necessityLack of long-term research and unknown effectsInfluence of social media and misinformationPersonal choice and autonomyDesire for more information and communication We then undertook semi structured interviews with volunteers to understand these concerns in greater depth and progressively developed a toolkit of resources around commonly reported concerns to inform shared decision making. Discussion of these resources with patients increased our understanding of the concerns in greater depth and permitted iterative improvements to the resource such that it reduced hesitancy in all respondents, garnering a self-reported reduction of 61% on a 1 to 5 Likert scale. More recently, we have noted a significant cohort of patients who, although they were happy to accept the initial offer of 2-3 doses, have not assented to have further booster doses. We therefore re-surveyed (July 2023). 44 patients replied. 20.5% had had no doses and only 11.4% had had the 5 doses recommended leaving 68.2% partially vaccinated (C). A similar age dependent increase in acceptance was seen (60% of under 16s unvaccinated vs.16.7% of 35 &amp; overs). Only 36.4% had accepted the offer of a broader coverage booster (D). There was an evolution in qualitative themes (E) Mistrust in/scepticism about vaccine technologyDoubts about vaccine efficacySide effects experiencedAnger at being singled out/‘forced’ to get boostersBoosters reminding of the pandemic's impact on mental health Most worryingly, there are statements regarding dissatisfaction with healthcare providers' responses regarding the vaccine and suggestions that continuing to promote the vaccine in the face of deep-rooted objections is eroding the doctor-patient relationship and level of trust and confidence in the team which is frequently hard won and highly prized by patients with SCD. Appreciating the causes of the underlying concerns and development of tailored interventions are necessary to develop targeted educational campaigns that address SCD-specific concerns, effective communication strategies that involve healthcare providers and patient advocacy groups, and the provision of accurate and transparent information. The more recent set of themes are more challenging to develop targeted resources towards, but they contain critical learning for physicians regarding the potential damage caused by promoting the vaccine too strongly to those who remain sceptical. By more fully understanding the sources of ongoing vaccine hesitancy among patients with SCD we can best support our patients to mitigate the potentially devastating consequences of the disease in this vulnerable population whilst maintaining the fragile therapeutic alliance.

Reducing Barriers to COVID-19 Vaccination Uptake: Community Ideas from Urban and Rural Kenya

Following the rapid development of COVID-19 vaccines, addressing vaccine hesitancy and optimizing uptake have emerged as critical challenges, emphasizing the importance of reducing barriers toward COVID-19 vaccination. This study investigates ideas on ways to reduce barriers to COVID-19 vaccination uptake. It explores methods that can overcome COVID-19 vaccination barriers through qualitative research: interviews and group discussions involving healthcare providers, administration personnel, teachers, and individuals with chronic conditions across urban (Mombasa) and rural (Kilifi) Kenya. Audio-recorded discussions were transcribed and thematically analyzed across locations. Five themes emerged in our results regarding the reduction in barriers to COVID-19 vaccination in the context of Kenya, including awareness campaigns, engaging diverse stakeholders, using various communication techniques, capacity building to increase vaccination centers and trained staff, and lastly, revising relevant government health policies and guidelines. These results indicate the importance of adopting multiple approaches, as no single strategy can boost vaccine acceptance. Moreover, this study provides recommendations for conceiving actionable interventions to potentially boost vaccine demand and maintain routine immunization in Kenya.