Mixed-methods Cross-sectional Design Research Articles

Perceptions of undergraduate medical students on artificial intelligence in medicine: mixed-methods survey study from Palestine

BackgroundThe current applications of artificial intelligence (AI) in medicine continue to attract the attention of medical students. This study aimed to identify undergraduate medical students’ attitudes toward AI in medicine, explore present AI-related training opportunities, investigate the need for AI inclusion in medical curricula, and determine preferred methods for teaching AI curricula.MethodsThis study uses a mixed-method cross-sectional design, including a quantitative study and a qualitative study, targeting Palestinian undergraduate medical students in the academic year 2022–2023. In the quantitative part, we recruited a convenience sample of undergraduate medical students from universities in Palestine from June 15, 2022, to May 30, 2023. We collected data by using an online, well-structured, and self-administered questionnaire with 49 items. In the qualitative part, 15 undergraduate medical students were interviewed by trained researchers. Descriptive statistics and an inductive content analysis approach were used to analyze quantitative and qualitative data, respectively.ResultsFrom a total of 371 invitations sent, 362 responses were received (response rate = 97.5%), and 349 were included in the analysis. The mean age of participants was 20.38 ± 1.97, with 40.11% (140) in their second year of medical school. Most participants (268, 76.79%) did not receive formal education on AI before or during medical study. About two-thirds of students strongly agreed or agreed that AI would become common in the future (67.9%, 237) and would revolutionize medical fields (68.7%, 240). Participants stated that they had not previously acquired training in the use of AI in medicine during formal medical education (260, 74.5%), confirming a dire need to include AI training in medical curricula (247, 70.8%). Most participants (264, 75.7%) think that learning opportunities for AI in medicine have not been adequate; therefore, it is very important to study more about employing AI in medicine (228, 65.3%). Male students (3.15 ± 0.87) had higher perception scores than female students (2.81 ± 0.86) (p < 0.001). The main themes that resulted from the qualitative analysis of the interview questions were an absence of AI learning opportunities, the necessity of including AI in medical curricula, optimism towards the future of AI in medicine, and expected challenges related to AI in medical fields.ConclusionMedical students lack access to educational opportunities for AI in medicine; therefore, AI should be included in formal medical curricula in Palestine.

Linguistic dissection of nursing handoffs: Implications for patient safety in varied-acuity hospital settings.

This study examines the intricate language and communication patterns of nurse-to-nurse handoffs across three units with varying patient acuity levels and nurse-patient ratios, seeking to identify linguistic factors that may affect the quality of information transfer and patient outcomes. A mixed-methods cross-sectional design. This study used the Nurse-to-Nurse Transition of Care Communication Model to explore the content and meaning of language in nursing handoffs within a large academic medical centre. Data were collected on three units through digital audio recordings of 20 handoffs between June and September 2022, which were transcribed and analysed using the Linguistic Inquiry Word Count programme. Trustworthiness was established by adhering to COREQ and STROBE guidelines for qualitative and quantitative research, respectively. Analysis revealed a preference for casual, narrative language across all units, with ICU nurses demonstrating a higher confidence and leadership in communication. Cognitive processes such as insight and causation were found to be underrepresented, indicating a potential area for miscommunication. Communication motives driven by affiliation were more pronounced in ICU settings, suggesting a strong collaborative nature. No significant differences were observed among the units post multiple testing adjustments. Speech dysfluencies were most pronounced in ICU handoffs, reflecting possible stress and cognitive overload. The study highlights the need for improved communication strategies such as interventions to enhance language clarity and incorporating technological tools into handoff processes to mitigate potential miscommunications and errors. The findings advance nursing science by highlighting the critical role of nuanced language in varied-acuity hospital settings and the necessity for structured nurse education in handoff communication and standardized handoff procedures. This study underscores the critical role of language in nurse-to-nurse handoffs. It calls for enhanced communication strategies, technology integration and training to reduce medical errors, improving patient outcomes in high-acuity hospital settings. Nurses only.

IJCM_118A: Pathway of healthcare for breast cancer: A mixed method study among women with breast cancer attending a tertiary healthcare institute in Bihar

Background: Breast cancer is the most common cancer among women; however, the majority of them visit hospitals at an advanced stage. Knowledge of pathway of care will aid in timely intervention and better prognosis. Objectives: To find the pathway of health care for breast cancer and its correlates among the patients who have attended AIIMS Patna. To identify the reasons for seeking delayed definitive care. Methodology: A mixed-method cross-sectional design with quantitative and qualitative parts was conducted at AIIMS Patna between March 2021 and December 2022 among breast cancer patients. A total of 171 breast cancer patients were enrolled in this study. Piloted study tools were used. Descriptive analysis for quantitative part and manual thematic analysis for qualitative part were performed. Results: Out of total 171 participants, 88.9% (83.3–92.77%) had visited AIIMS Patna indirectly. About 60 (20.6%) visited informal providers or quacks, and 60 (39.5%) of the study participants visited more than one hospital before arriving at AIIMS Patna. The place of residence, treatment delay, and stage of cancer were found to be independent predictors of the pathway of healthcare for breast cancer. The reasons behind seeking delayed definitive care were identified under two major themes: presentation delay (misunderstanding or difficulty in identifying symptom, neglect of disease, lack of awareness about the disease, family support, financial constraints) and treatment delay (misdiagnosis, multiple referrals, dissatisfaction with the treatment, COVID-19 lockdown, informal providers/quacks) Conclusion: 9 out of 10 breast cancer patients had not come directly for definitive care, and among them, 3 out of 5 had visited multiple healthcare providers. So, it is important to educate the public on breast cancer, make systematized referral pathways, orient the private sector, and have trained manpower for screening purposes.

Listen to the voices of nurses: the role of community chief nurses and registered nurses in the provision of care for older people in Sweden during the COVID-19 pandemic – a cross-sectional study

BackgroundDuring the pandemic in Sweden, the aim was to protect older people, especially those among them who were sick, frail and vulnerable in residential care facilities. A ban was put on visits at all residential care facilities in March 2020 to prevent the spread of infection among the older people. This study aims to describe the experiences of Community Chief Nurses and Registered Nurses who provided medical and nursing care for older people in residential care facilities and home care during the first wave of the COVID-19 pandemic, and to examine factors associated with the quality of care.MethodsThe study has a mixed method cross-sectional design (STROBE). Data were collected using a web-based survey that comprised two questionnaires, for Community Chief Nurses and Registered Nurses developed for the study. Data were analysed using descriptive statistics and logistic regression models, as well as qualitative content analyses.ResultsThe majority of Community Chief Nurses reported adequate opportunities to work with management to handle the COVID-19 pandemic. The Registered Nurses reported that the quality of care, as well as the person’s safety, was negatively affected during the pandemic. Factors associated with good care were as follows: information-sharing; ability to comply with hygiene practices; competence in how to care for older persons with COVID-19; a physician at bedside assessing their health; and support from frontline managers.ConclusionThe study highlights crucial facets that care organizations must address to enhance their readiness for future pandemics or disasters, ensuring the security and well-being of the older people.

Providers' Understanding of Cancer Aetiology and Supportive Features for Indigenous Palliative Cancer Care Service Provision in Kenya.

Palliative care is a fundamental component of providing people-centred health services to cancer patients. However, the primary pillars of indigenous palliative care such as provider understanding of cancer, its aetiology, and features are undocumented. We sought to understand Traditional Health Providers (THPs) understanding of cancer aetiology, and the functional features that support indigenous palliative cancer care service provision in Kenya. The study used a mixed methods cross-sectional design. A semi-structured questionnaire was administered to 193 THPs, who self-reported to manage cancer patients. The findings were enriched and validated through member checking in 6 focus group discussions and five journey mapping in-depth interviews. Despite diversity in culture and experience among the indigenous providers in Kenya, their description of cancer etiology and their management practices and primary goal were similar. Cancer was consistently described as a deadly life-deforming disease by 61.1% of THPs (n = 118/193) and attributed to chemicals and toxins in the body 41.5% (n = 80). The indigenous palliative-care system was reported to be characterized by five tiered levels of care, diversity in expertise and experience, shared and consultative process (60%) and family involvement in medical decision (59.5%). Herbal regimen (60.1%) was found to be the cornerstone of informal palliative care blended with nutrition management 78.2% (n = 151), lifestyle changes 63.7% (n = 123) and counseling services 55.9% (n = 108). Payments for service were arbitrarily made in cash or in kind. The features of indigenous palliative care services are informed by the providers' distinctive cultural terms and descriptions of cancer and cancer aetiology. Shared and consultative protocols, regimen exchange, referral to cascaded care, and caregiver involvement were all important palliative-care clues to saving and enhancing lives. The features provide context for development of indigenous palliative care framework, engagement of policy makers, and promotion of culturally-inclusive indigenous palliative care model for adoption.

Assessment of availability, readiness, and challenges for scaling-up hypertension management services at primary healthcare facilities, Central Highland region, Vietnam, 2020

IntroductionVietnam aims for 95% of commune health stations (CHSs) to have functional hypertension management programs by 2025. However, limited resources may impede the Central Highland region health system from achieving this goal. We assessed the availability and readiness of hypertension management services at CHSs in the Central Highland region and identified challenges to facilitate evidence-based planning.MethodsWe used a mixed-methods cross-sectional design to assess hypertension management services using WHO’s service availability and readiness assessment (SARA) tools in all 579 CHSs in the region, combined with twenty in-depth interviews of hypertension program focal points at communal, district, and provincial levels in all four provinces. We descriptively analyzed quantitative data and thematically analyzed qualitative data.ResultsHypertension management services were available at 65% of CHSs, and the readiness of the services was 62%. The urban areas had higher availability and readiness indices in most domains (basic amenities, basic equipment, and essential medicines) compared to rural areas, except for staff and training. The qualitative results showed a lack of trained staff and ambiguity in national hypertension treatment guidelines, insufficient essential medicines supply mechanism, and low priority and funding limitations for the hypertension program.ConclusionThe overall availability and readiness for hypertension diagnosis and management service at CHSs in the Central Highland region were low, reflecting inadequate capacity of the primary healthcare facilities. Some measures to strengthen hypertension programs in the region might include increased financial support, ensuring a sufficient supply of basic medicines, and providing more specific treatment guidelines.

Perceived Nexus Between Non-Invigilated Summative Assessment and Mental Health Difficulties: A Cross Sectional Studies

The COVID-19 pandemic rapidly led to changes in the mode of teaching, learning and assessments in most tertiary institutions worldwide. Notably, non-invigilated summative assessments became predominant. These changes heightened anxiety and depression, especially among individuals with less resilient coping mechanism. We explored the perceptions and experiences of mental health difficulties of students in tertiary education regarding non-invigilated alternative assessments in comparison to invigilated assessments. A pragmatic, mixed method cross sectional design was conducted online via Qualtrics. Thematic analysis of text was carried out using NVivo 12. In the quantitative analysis, univariable and multivariable ordinal logistic models were used to examine the potential factors for preference among students in higher education. A total of 380 Nursing and Social Science students responded to the survey. Approximately 77% of students perceived non-invigilated assessments to be less stressful compared to invigilated exams. Age, course of study, stage of studies, and number of units enrolled per semester were identified as significant drivers for students’ perceived preference for non-invigilated assessments. There was an inverse relationship between the perception of stress associated with invigilated exams and the age of students. For instance, students aged between 18-24 were 5 times more likely to prefer non-invigilated exams compared to those aged 55 or more. Comparatively, students in early stages of studies had higher preference for non-invigilated assessments. However, there was a preference reversal for students enrolled in 2 or less units per semester. Social sciences students were two times more likely to prefer non-invigilated examinations to invigilated examinations compared to nursing students. The findings reinforce the use of alternative assessments in higher education as a mitigating agency to lessen the mental health burden of tertiary students in post COVID-19 era.

Livelihood Strategies and Their Determinants among Informal Households in Calabar, Nigeria

The purpose of investigating livelihood strategies is to seek patterns that can be acted upon in order to improve livelihood prospects. This paper assesses household livelihood strategies and their determinates by asking (1) how urban households manage and mobilise resources and (2) how they combine assets—emphasising the existing strategies they adopt and their outcomes. Using a mixed-method cross-sectional design, four informal settlements were surveyed. Household questionnaires were developed and used to collect data from 425 households in Calabar, Nigeria. A total of 45 interviews, non-participant observation, and 2 focus groups were conducted. Quantitative data were analysed using the Statistical Package for Social Science (SPSS version 26, IBM, Armonk, NY, USA) and presented using tables. The qualitative data were collected, coded and analysed using NVivo 1.2 (QRS International). Fundamental context-related livelihood strategies in asset building are identified, and the diverse approaches and constraints that emerged are analysed. The result shows that households diversify their assets with strategies which are complex and diverse. This ranges from the extension of spaces and sub-letting a room to reducing their expenses (by spending less), borrowing from friends and relatives, and seeking help from community organisations. Others include pawning their belongings, engaging in home-based enterprises, and investing in children’s education, migration, and urban agriculture. Findings further indicate the ability of households to avoid or reduce their vulnerability and to increase their productivity depends on their initial assets and on their ability to transform them into income, food, or other necessities. This paper recommends ways of strengthening and supporting households’ strategies to cope with and reduce housing vulnerability.

"I'm Going to Tell You Something I Never Told Anyone": Ethics- and Trauma-Informed Challenges of Implementing a Research Protocol with Syrian Refugees.

As research subjects, refugees have numerous potential vulnerabilities. This study aimed to examine the ethics- and trauma-informed challenges of implementing a mental health research protocol with Syrian refugees living in Portugal. Guided by the integrated meaning-making model, the research project "Journeys in Meaning" employed a mixed-methods cross-sectional design to explore posttraumatic cognitive processing in refugees using two phases of data collection: two focus groups (Phase 1) to test the protocol and 39 in-depth individual interviews (Phase 2) to implement the protocol. Results examine the strategies used to address the following: methodological challenges related to protocol design, participant recruitment, and language; ethics- and trauma-informed challenges aimed at minimizing harm and maximizing benefit to participants that followed social justice principles; and perceived compassion fatigue on the part of the researcher following repeated empathetic exposure to traumatic content. Findings suggest the need for adaptive approaches to research with refugee populations that challenge strict compliance with the traditional principles of "do no harm" and researcher neutrality, and that accommodate individual and community complexities.

Adherence level to the World health Organization surgical safety checklist and associated factors in operating rooms in a county teaching and referral hospital in South-Western Kenya

IntroductionWorld Health Organization (WHO) introduced the Surgical Safety Checklist (SSC) in 2008 to assure safety in Operating Rooms (ORs). Globally, adherence level varies with developing countries having the lowest levels compared to their developed counterparts. ObjectivesWe aimed to assess the level of adherence and identify factors that influence adherence to the WHO SSC in a county teaching and referral hospital in South Western Kenya. MethodsThe study preferred a mixed method cross-sectional design. WHO SSC adherence level was assessed by conducting a retrospective review of 424 surgical files that were randomly selected. OR staff (40) were targeted using census method and 31of them were interviewed using structured interviews to determine qualitative data on staff and institutional factors that influenced adherence practices to the WHO SSC. Quantitative data was analysed using Statistical Package for Social Sciences (SPSS). Both descriptive and analytical statistics were generated with statistical significance set at p=<0.05. Content analysis was adopted for qualitative data. Study FindingsWHO SSC was present in 100 % of the post-surgical files. Filling of the WHO SSC was attempted in 7.1 % of the surgeries done. Better adherence was noted in elective surgeries (78 %) compared to emergency (22%) ones. There was a varying adherence level per the type of surgeries with adult general surgeries posting better adherence (40 %) and orthopaedic surgeries were least adherent at 4 %. A decreasing trend in adherence level was noted subsequently through the three moments of surgery (‘sign in’ (5.7 %); ‘Time out’ (1.8 %); and ‘Sign out’ (0.7 %)). The average adherence level was established to be 2.7 %. Key staff factors that influenced adherence practices included; years of experience (p = 0.004), attitude (p = 0.014) and perception(p = 0.009). Additionally, institutional factors were; lack of essential consumables and drugs (77.4 %), lack of refresher trainings (54.5 %), understaffing (48.4 %) and lack of management support (45.2 %). ConclusionThe level of adherence to the WHO SSC was critically low. The aforementioned staff and institutional factors influenced the level of adherence. The study recommends a structured health system-based quality improvement intervention to improve the outcome (adherence) by addressing the root causes (Staff and institutional) to promote patient safety in OR.

Technology use as a sleep-onset aid: are adolescents using apps to distract themselves from negative thoughts?

The aim of this study was to; (1) explore whether adolescents use technology as distraction from negative thoughts before sleep, (2) assess whether adolescents who perceive having a sleep problem use technology as distraction more compared to adolescents without sleep complaints, and (3) collect qualitative information about which devices and apps adolescents use as a distraction. This study used a mixed-methods cross-sectional design, where 684 adolescents (M = 15.1, SD = 1.2, 46% female) answered both quantitative and qualitative questions about their sleep (perceived sleep problem, sleep onset time (SOT), and sleep onset latency [SOL]) and technology use as distraction from negative thoughts. The majority of adolescents answered "yes" or "sometimes" using technology as a distraction from negative thoughts (23.6% and 38.4%). Adolescents who answered "yes" to using technology as distraction were more likely to report having a sleep problem, longer SOL, and later SOT, compared to adolescents who answered "no". The most popular device to distract was the phone, because of its availability, and the most common apps used for distraction included YouTube, Snapchat, and music apps. This study shows that many adolescents use technology to distract themselves from negative thoughts, which may help them manage the sleep-onset process. Thus, distraction may be one mechanism explaining how sleep affects technology use, rather than vice versa.

Examining Perceptions Of Religious Coping, Health-Related Quality Of Life, And Healthcare Support Of ALS Caregivers

<h3>Research Objectives</h3> This cross-sectional study (N=8) built on a prior longitudinal case study (N=1) with a similar aim; that of understanding ALS caregiver experiences by exploring declines in swallowing and communication in ALS patients based on the results of one qualitative and two quantitative measurements. <h3>Design</h3> A mixed method cross-sectional design. <h3>Setting</h3> The interviews were conducted over the phone, per Centers for Disease Control and Prevention (CDC) social distancing guidelines. <h3>Participants</h3> Eight informal (non-compensated) family caregivers of ALS patients. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> 1) Qualitative interviews, 2) the Brief RCOPE (a 14-item measure of positive and negative religious coping with major life stressors), and 3) a health-related quality of life survey instrument (SF12v2). <h3>Results</h3> Interview data revealed anxiety related to anticipated losses and capacity to meet progressive unrelenting needs of care receivers. In addition, caregivers reported an increased burden as the disease progressed, perceiving a lack of medical personnel training necessary to meet their needs. Caregivers' religious coping ratings attested to feelings of less connectedness with God as the disease progressed. Health quality of life measures suggested emerging issues based on health status, energy levels, pain, and available time for responsibilities. <h3>Conclusions</h3> The unique challenges of ALS caregiver experiences and burdens consist of complex emotional, clinical, financial, secondary supportive care needs, and environmental issues. These perceived experiences and burdens have clinical implications for improved communication in working with caregivers to better meet their needs. <h3>Author(s) Disclosures</h3> Nothing to disclose.

Implicit Racial Bias, Health Care Provider Attitudes, and Perceptions of Health Care Quality Among African American College Students in Georgia, USA.

Due to racism, over 20% of African Americans, including college students in Georgia, receive poor quality health care. Consequently, most students are reluctant to utilize health care services in the state. This study examined biased racial attitudes of health care providers in Georgia, and African American Georgia State University (GSU) School of Public Health (SPH) students' perceptions of the quality of health care they receive from providers, the effects of such care, and student recommendations for the way forward. A mixed-methods cross-sectional design was used to collect data from 63 students across six domains using Qualtrics. Provider brushes off patient concerns when providing medical care (29.9%), stereotyping (26.9%), and the lack of communication during medical care (25.4%) were the three main implicit racial attitudes identified by GSU SPH students. Owing to the poor quality of care they receive from their health care providers, some students (28.4%) are reluctant to utilize health care services, distrust doctors that are not from their race (34.3%), do not adhere to treatment (19.4%), and prefer to use home remedies (28.4%) when ill. Students recommended cultural competency training, holding health care providers accountable for their actions, and increasing African American health care providers in Georgia as ways to address health care provider attitudes and quality of care. Negative provider attitudes impact the health and health-seeking behavior of African American college students in Georgia. These attitudes must be eliminated so barriers to clinical participation are removed, and student health outcomes optimized.

Manager, coach and sports club participant perceptions of health promotion

Objectives: Sports clubs’ investment in health promotion (HP) has so far been limited, and efforts to understand where gaps exist in implementation are few and far between. This mixed-method study analysed managers’, coaches’ and sports participants’ perceptions of HP in a single sports club. Design: A mixed-method cross sectional design was used. Setting: The goal was to assess HP perceptions at the macro (club), meso (managers) and micro (coaches) levels with respect to four key health determinants. Method: Quantitative data were collected from 237 participants using e-PROSCeSS questionnaires. Qualitative data collection included two meetings with managers and a focus group with sports club participants. Data analysis took place by means of a hybrid thematic analysis informed by the health promoting sports club (HPSC) model. Results: Similar answer patterns among managers, coaches and sports club participants illustrated that social and environmental determinants scored higher than organisational and economic determinants, which was consistent with qualitative findings. Only one significant difference was found between managers and sports club participants – for organisational determinants at the macro level. In others words, all club actors agreed that sports clubs needed to invest in HP policy and funding, and not only acknowledge that HP is an integral outcome of sports participation. Gender differences in HP perceptions were identified, while being a volunteer compared to a non-volunteer did not make any significant difference. Conclusion: Study findings raise questions about how best to implement and evaluate sports club HP, especially in relation to policies and resources. This is essential to understand the interactions between macro, meso and micro level health determinants and the temporal implications of implementing a HPSC’s approach.

Predictors for stress in special education teachers: Policy lessons for teacher support and special needs education development during the COVID pandemic and beyond

ABSTRACT There has been little research on the challenges facing special education teachers (SETs), since the COVID-19 pandemic. This study aimed to identify SETs predictors for stress and barriers to teaching effectiveness. Using a mixed methods cross-sectional design we sampled six public sector special needs institutes. A total of 205 quantitative surveys and 21 qualitative interviews were collected, respectively. Logistic bivariate regression results revealed seven factors predicting higher stress in SETs and qualitative themes further shed light on barriers to teacher efficacy. We conclude with key recommendations for the Special Education Sector and support for SETs, with implications for other developing regions. Abbreviations: SET: special edcation teachers; SSN: students with special needs

Caring for Psychological Distress of Patients With COVID-19: A Mixed-Method Cross-Sectional Study.

IntroductionThe 2019–2020 pandemic COVID-19 has become a global health crisis. While many recent studies on COVID-19 pandemic have focused on disease epidemiology and psychological status of patients, few have explored the multi-facet influential factors or combined perspectives from both the patients and healthcare workers. The purposes of this study were to: analyze the influencing factors of psychological distress of COVID-19 patients; and describe the experience of healthcare workers relieving psychological distress.Materials and MethodsThis study uses a mixed-method cross-sectional design, including a quantitative study and a qualitative study, targeting two populations: COVID-19 patient and health workers, respectively. In the quantitative part, we recruited a convenience sample of patients with COVID-19 from five hospitals in Wuhan, Hubei Province from 10 to 15 April, 2020. Besides, we collected data by using participants’ socio-demographic information sheet, the Connor-Davidson Resilience Scale-10, the Herth Hope Index, the Distress Thermometer, the Revised Chinese Version of Mishel Uncertainty in Illness Scale, and the Chinese Version of Wake Forest Physician Trust Scale. In the qualitative part, the participants were healthcare workers involved in medical aid missions in Hubei Province, China. Meanwhile, we used sampling with convenient and purposive, data collection with a semi-structured online video interview, and text transcription with Colaizzi’s phenomenological method.ResultsThe results reveal that 25.7% of patients reported higher level of psychological distress (n = 31, scoring ≥4). After controlling the sociodemographic variables, only severity of COVID-19 (β = 0.282, P = 0.025) and uncertainty in illness (β = 0.345, P = 0.007) shown significant effect on psychological distress in the regression model (F = 10.862, R2 = 0.222, P < 0.001). The experience of healthcare workers emerged five themes: Particularly needed psychological care, Manifestation of negative emotion, Manifestation of proactive adaptation, Strategies relieving psychological distress, and gains of healthcare workers after delivering effective psychological care.ConclusionThe 25.7% of patients with COVID-19 still suffered from psychological distress, which should receive timely attention from healthcare workers. And the severity of the disease and disease uncertainty have a significant impact on distress. It is critical to train the healthcare workers on detecting the different manifestation of psychological distress, offering timely disease related information, and applying communication strategies.

Communication needs for improved uptake of PrEP and HIVST services among key populations in Nigeria: a mixed-method study

BackgroundWorld Health Organization (WHO) reports that people who indulge in risky behaviours such as penile-anal sex, unprotected intercourse, multiple sex partners, and alcohol and illicit drugs are at risk of HIV/AIDS and classified as Key Populations (KPs). Since the introduction of PrEP and HIVST for the key population groups in Nigeria, government entities and implementing partners have used a range of channels in messaging these essential services across to the target groups—ranging from in-person, social media, television, and radio adverts. Yet, few successes have been documented, thereby necessitating the need to understand the enabling facilitators, barriers to, and communication needs of the KP groups in messaging PrEP and HIVST services in Nigeria. Communicating PrEP and HIVST services will empower the key populations to seek available HIV prevention services and help to increase access to HIV testing services in Nigeria.MethodsThis study was a mixed-method cross-sectional design; involving 1169 participants from the key populations in Nigeria. The study used a survey and qualitative exploratory methods (interviews and focus group discussion), to collect data from the participants—MSM, FSWs, and key influencers of the KP groups (health providers, peer educators, HIV program officers). In August 2020, data collection was conducted using an open data kit (ODK). Quantitative data were analyzed using SPSS version 20 for descriptive statistics, while qualitative data were analyzed using deductive and thematic analysis based on the codebook.ResultsThe KPs were mainly urban dwellers (77.7%), and the majority of the participants were between 18 to 28 years (89.3%). However, the MSM group was of a younger population compared to the FSWs. A majority completed secondary education (56.1% FSWs and 43.5% MSM). The MSM group showed more tendency to acquire higher education compared to the FSWs. For example, about 51.3% of the MSM group were undergraduates compared to 9.5% of the FSWs. The majority of the KPs were self-employed (56.4% FSWs and 40% MSM). Only about 51% of the KPs were aware of PrEP, with typological variations (39.9% FSWs and 62.3% MSM). MSM group in Lagos (82.5%) were more aware of PrEP services, than 53.1% and 54.5% in A/Ibom (53.1%) and C/River (54.5%). Among the enablers to acquiring PrEP information was the ability of the KPs to network within their communities and on personal relationships. Evidence shows that no single approach influenced the acquisition and use of PrEP information by KPs. Although this proportion varied across the geographic locations, only about 50% of the KPs were aware of HIVST services (40% FSWs and 60% MSM). The factors that enabled the acquisition and use of the prevention commodities were cross-cutting, including a previous or current role as a peer educator, integration of the messages, peer networking, multi-lingual and multi-channel presentation, job aids, and reminders. KPs expressed the need for information on how to take PrEP, eligibility, clarification on differences between PrEP and PEP, clarification on any side effects, for PrEP, price, efficacy, sales point, dosage, available brands. A scale-up of the research across all geopolitical zones and a survey to quantify the prevalence would help understand the dynamics and prioritization of interventions for scaling up PrEP and HIVST services in Nigeria.ConclusionsThe study documented barriers and facilitators to the uptake of PrEP and HIVST among key populations in Nigeria. It highlighted that KPs are willing to receive PrEP and HIVST messages. The policy actors should consider the preferences of the KPs and the key influencers in reducing barriers to communication and increasing the uptake of PrEP and HIVST services; ensure it reflects in a tailored communication strategy. Since multi-linguistics and multi-channels of presentation were enablers to acquiring PrEP and HIVST messages, the communications strategy for HIV prevention should incorporate these recommendations and adapt to context-specific approaches for effective messaging.

Determinants and perception of health insurance participation among healthcare providers in Nigeria: A mixed-methods study

BackgroundTo accelerate universal health coverage, Nigeria’s National Health Insurance Scheme (NHIS) decentralized the implementation of government health insurance to the individual states in 2014. Lagos is one of the states that passed a State Health Insurance Scheme into law, in order to expand the benefits of health insurance beyond the few residents enrolled in community-based health insurance programs, commercial private health insurance plans or the NHIS. Public and private healthcare providers are a critical component of the Lagos State Health Scheme (LSHS) rollout. This study explored the determinants and perception of provider participation in health insurance programs including the LSHS.MethodsThis study used a mixed-methods cross sectional design. Quantitative data were collected from 60 healthcare facilities representatively sampled from 6 Local Government Areas in Lagos state. For the qualitative data, providers were interviewed using structured questionnaires on selected characteristics of each health facility in addition to the managers’ opinions about the challenges and benefits of insurance participation, capacity pressure, resource availability and financial management consequences.ResultsA higher proportion of provider facilities participating in insurance relative to non-participating facilities were larger with mid to (very) high patient volume, workforce, and longer years of operation. In addition, a greater proportion of private facilities compared to public facilities participated in insurance. Furthermore, a higher proportion of secondary and tertiary facilities relative to primary facilities participated in insurance. Lastly, increase in patient volume and revenue were motivating factors for provider facilities to participate in insurance, while low tariffs, delay and denial of payments, and patients’ unrealistic expectations were mentioned as inhibiting factors.ConclusionFor the Lagos state and other government insurance schemes in developing countries to be successful, effective contracting and quality assurance of healthcare providers are essential. The health facilities indicated that these would require adequate and regular provider payment, investments in infrastructure upgrades and educating the public about insurance benefit plans and service expectations.

Social Anxiety Symptoms in Survivors of Childhood and Adolescent Cancer.

Purpose: Adolescent and young adult (AYA) cancer survivors may be at risk of developing symptoms of social anxiety disorder (SAD) due to disruptions in social participation and functioning following a cancer diagnosis. This study aimed to explore (1) the proportion of Australian AYA-aged survivors of childhood and adolescent cancer who experience symptoms of SAD, (2) how symptoms of SAD are described by survivors as affecting their daily social functioning. Methods: A mixed-methods cross-sectional design was employed, inviting survivors, aged 13-25 years, who had completed treatment between one and ten years ago. Survivors completed a paper-based questionnaire, containing validated measures of SAD, and an optional semistructured interview assessing current social functioning and social anxiety. Results: Twenty-seven survivors aged 13-25 years participated (M = 19.15, 51.9% male, and 7 years post-treatment). Nine (33%) participants reported clinically significant symptoms of SAD. In interviews, survivors reported worries about how others perceived them and fears around meeting new people. Survivors described that this impacted their daily social functioning, leading them to avoid, or endure with distress, feared social situations. Conclusion: This study shows that clinically significant social anxiety may be a concern for a subset of survivors of childhood/adolescent cancer. Identifying which young people are at risk of SAD after cancer and how best to support this vulnerable cohort is critical.

Expert Perspectives on Effective Community-Based Pediatric Healthcare for Low-Income Latino Families: Persistent Issues over Time.

US Latinos continue to experience significant health inequity, despite fluctuating healthcare policies over the past 20 years. Recent studies highlight the importance of comprehensive care and collaboration of stakeholders in reducing inequity. Few studies examine the perspectives of community-based organization leaders, health researchers, and policy experts regarding the most effective practices in the delivery of healthcare to Latino children and families. This unique study employed a mixed-methods cross-sectional design to compare perceptions of effective practices and action strategies among two groups. Analysis of qualitative data gathered from 17 organizational leaders and 28 research/policy experts resulted in four broad themes: (1) engagement of families as participants in their healthcare; (2) provision of comprehensive, family-focused healthcare services across the lifespan; (3) engagement of ethnically competent staff to provide outreach; and (4) development of community collaborations for resource building. Respondents identified three major barriers to the provision of high-quality care: (1) inequities in social determinants; (2) ongoing changes in insurance coverage; and (3) funding challenges for the support of community-based health centers (CHCs). Although the data were collected in 2001, these thematic findings remain relevant given the persistence of inequities and the lack of progress in mitigating inequity among Latino children and families, despite evolving healthcare system changes. The study conclusions reaffirm the importance of community-driven preventive healthcare services across the life course. These community services are the frontline of healthcare for many Latino children and their families; therefore, their sustainability is crucial. The voices of organizational leaders, health research, and policy experts are important and relevant.