Service Model Research Articles

Research on Effective Supply Strategies of Informationization Teaching Resources under the Background of "Double Reduction"

The quality of education after the "double reduction" needs to be guaranteed by deepening education and teaching reform. In order to better implement the "double reduction", it is necessary to apply information technology teaching methods to promote educational reform. At the same time, deepening information technology teaching reform is also an effective measure to promote the common and balanced development of compulsory education. In the society where information technology teaching is constantly developing, information resources are everywhere. In the context of "double reduction", the study of effective supply strategies for high-quality information technology education resources is conducive to the realization of reducing burden, increasing efficiency, and improving the quality of education environment. On the basis of explaining how information technology education resources can empower the implementation of "double reduction", this study proposes effective supply strategies for information technology education resources from the perspectives of precise promotion of teaching resources and teaching services, hierarchical supply of after-school service resources, big data resources to assist school work, and transformation of service models for off campus institutions.

Investigating changes in student mental health and help-seeking behaviour after the introduction of new well-being support services at a UK university.

Growing numbers of students now seek mental health support from their higher education providers. In response, a number of universities have invested in non-clinical well-being services, but there have been few evaluations of these. This research addresses a critical gap in the existing literature. This study examined the impact of introducing non-clinical well-being advisers on student mental health and help-seeking behaviour at a large UK university. Survey data collected pre-post service introduction in 2018 (n = 5562) and 2019 (n = 2637) measured prevalence of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), and low mental well-being (Warwick-Edinburgh Mental Wellbeing Scale), alongside student support-seeking behaviour. Logistic regression models investigated changes in outcome measures. Administrative data (2014-2020) were used to investigate corresponding trends in antidepressant prescribing at the onsite health service, student counselling referrals and course withdrawal rates. Adjusted models suggested reductions in students' levels of anxiety (odds ratio 0.86, 95% CI 0.77-0.96) and low well-being (odds ratio 0.84, 95% CI 0.75-0.94) in 2019, but not depression symptoms (odds ratio 1.05, 95% CI 0.93-1.17). Statistical evidence showed reduced student counselling referrals, with antidepressant prescribing and course withdrawal rates levelling off. Student perception of the availability and accessibility of university support improved. Our findings suggest a non-clinical well-being service model may improve student perception of support, influence overall levels of anxiety and low well-being, and reduce clinical need. The current study was only able to examine changes over the short term, and a longer follow-up is needed.

Youth not engaged in education, employment, or training: a discrete choice experiment of service preferences in Canada

BackgroundPrior research has showed the importance of providing integrated support services to prevent and reduce youth not in education, employment, or training (NEET) related challenges. There is limited evidence on NEET youth’s perspectives and preferences for employment, education, and training services. The objective of this study was to identify employment, education and training service preferences of NEET youth. We acknowledge the deficit-based lens associated with the term NEET and use ‘upcoming youth’ to refer to this population group.MethodsCanadian youth (14–29 years) who reported Upcoming status or at-risk of Upcoming status were recruited to the study. We used a discrete choice experiment (DCE) survey, which included ten attributes with three levels each indicating service characteristics. Sawtooth software was used to design and administer the DCE. Participants also provided demographic information and completed the Global Appraisal of Individual Needs–Short Screener. We analyzed the data using hierarchical Bayesian methods to determine service attribute importance and latent class analyses to identify groups of participants with similar service preferences.ResultsA total of n=503 youth participated in the study. 51% of participants were 24–29 years of age; 18.7% identified as having Upcoming status; 41.1% were from rural areas; and 36.0% of youth stated that they met basic needs with a little left. Participants strongly preferred services that promoted life skills, mentorship, basic income, and securing a work or educational placement. Three latent classes were identified and included: (i) job and educational services (38.9%), or services that include career counseling and securing a work or educational placement; (ii) mental health and wellness services (34.9%), or services that offer support for mental health and wellness in the workplace and free mental health and substance use services; and (iii) holistic skills building services (26.1%), or services that endorsed skills for school and job success, and life skills.ConclusionsThis study identified employment, education, and training service preferences among Upcoming youth. The findings indicate a need to create a service model that supports holistic skills building, mental health and wellness, and long-term school and job opportunities.

P.028 Exploring young adult stroke patients’ lived experience, healthy lifestyle habits, and recommendations for designing innovative brain care-related initiatives

Background: Over the past decade, worldwide stroke incidence has been increasing among young adults (≤65years), which has implications during the most dynamic period of their life. There is a dearth of research exploring young adults stroke patients’ experiences, healthy lifestyle habits, preferences, and recommendations for brain care-related initiatives. The study aimed to gain knowledge and a deeper understanding of young adult stroke patients’ experiences, lifestyle habits, and support needs for brain care-related education and interventions. Methods: A descriptive qualitative study was used. Participants who took part in the quantitative phase of a larger mixed methods study (n=103 that expressed an interest in the qualitative phase, were invited to take part in semi-structured focus groups. Simultaneous data collection and analysis are being conducted. Data are being analyzed using inductive thematic analysis outlined by Braun and Clarke (2006). Results: Findings will be available by May 20, 2024. Conclusions: Study findings will be essential to 1) mobilize an understanding of young adult stroke patients’ lived experience; 2) reconceptualize the current model of stroke care and services that is traditionally geared towards older adults; and 3) inform the development of brain care-related education and interventions to meet the unique needs, priorities, and preferences of young adult stroke patients.

The process of co-designing a model of social prescribing: An Australian case study.

Social needs such as housing, employment, food, incomeand social isolation are having a significant impact on individuals, familiesand communities. Individuals are increasingly presenting to health settings with social needs, which are ill-equipped to address nonmedical needs. Social prescribing is a systematic approach connecting the health, social and community sectors to better address social needs and improve health and wellbeing. Social prescribing interventions are being implemented world-wide. With variability in health and social care systems internationally, it is important that social prescribing interventions are co-designed with key stakeholders to ensure they can be implemented and sustained within local systems. This Australian case study provides a detailed description of the process undertaken to co-design a social prescribing service model in a regional area. Four co-design workshops were undertaken, two with health and social care professionals and two with community members. The project followed an iterative process of resourcing, planning, recruiting, sensitising, facilitation, reflectionand building for change across the workshops. Through this process, key stakeholders were able to successfully co-design a social prescribing model of care for the region. By demonstrating the process and materials used in our project, we aim to open the 'black box' of co-design for social prescribing and provide ideas and resources for others to adapt and utilise. The project was designed and undertaken by a steering committee comprising university-based researchers (authors C. O. andS. B.), local government (author D. A.)and health, socialand community services (authors B. G., M. W., J. O.andS. R.). Members of the steering committee participated in project design, participant recruitment, workshopfacilitation, data analysisand interpretation.

The impact of low-cost carriers on high-quality producers in the aviation industry: cost-benefit analysis

PurposeThis paper aims to examine the low-cost carriers (LCC) impact on the high-quality carriers (HQC) in the aviation industry. The impact of LCCs on high-quality producers in the aviation industry has been a significant and multifaceted phenomenon.Design/methodology/approachThe study employs a captivating case study approach, investigating into the intricate fabric of the subject matter. Interviews serve as the cornerstone of primary evidence, offering first-hand insights, while secondary data sourced from documents adds depth to the exploration of the challenges encountered by the HQC.FindingsThe study concludes that LCCs have disrupted the traditional aviation landscape by offering low fares, simplified service models and aggressive cost-cutting strategies. This disruption has affected both the high-quality producers, such as full-service airlines. Full-service airlines have adopted a strategy of segmenting their market by offering multiple fare classes, with varying levels of service and flexibility. This allows them to target both price-sensitive travelers and those seeking premium services, catering to a broader customer base. The competition from LCCs has spurred innovation within the aviation industry, leading to advancements in technology, digital services and operational efficiency. Airlines, both LCCs and traditional carriers, have had to adapt to evolving consumer preferences and embrace digital solutions for booking, check-in and in-flight services.Research limitations/implicationsWhile this study provides a valuable cost-benefit analysis of the impact of LCC on high-quality producers in the aviation industry, it is essential to acknowledge its limitations and recognize the avenues for future research to further enhance our understanding of this complex and evolving industry landscape. While this study contributes valuable insights into the impact of LCCs on high-quality producers in the aviation industry, it is essential to recognize its limitations and identify opportunities for future research to expand our understanding of this complex and dynamic landscape. By addressing these limitations and exploring new avenues of inquiry, we can continue to advance our knowledge and inform evidence-based decision-making within the industry.Originality/valueThis study pioneers an exploration into the intricate tapestry of factors molding the future of the aviation sector. Through its groundbreaking analysis, it furnishes indispensable insights for industry stakeholders, policymakers and the discerning traveling public, setting a new benchmark for understanding and navigating the aviation landscape.

Innovation and Practice of "yae920.com" One-stop Service Mode from the Perspective of Digital Transformation

With the deepening of digital transformation, the medical service industry is facing huge innovation opportunities and challenges. This paper studies the "yae920.com" one-stop service model and discusses the impact of digital transformation on its service innovation and practice. The study first analyzed the overall impact of the digital transformation on the medical service industry, including the optimization of the service process, the improvement of the patient experience, and the improvement of the operational efficiency. Then, through the method of case study, it expounds how "yae920.com" innovates the one-stop service mode in the process of digital transformation, including the integration and optimization of functions such as online appointment registration, online consultation and consultation, electronic prescription circulation, online drug purchase and distribution and so on. The research also deeply explores the challenges and coping strategies encountered by "yae920.com" in the process of service model innovation, as well as the practical results achieved. The research results show that the digital transformation provides strong support for the innovation of the "yae920.com" one-stop service mode, and effectively improves the service efficiency and patient satisfaction. The research in this paper has certain reference value for promoting the digital transformation and service mode innovation of the medical service industry.

Midwives' and registered nurses' role and scope of practice in acute early pregnancy care services: a scoping review.

The objective of this scoping review was to investigate and describe what is reported on the role and scope of practice of midwives and registered nurses providing care for women with pregnancy complications under 20 weeks' gestation in acute clinical settings in Australia. In many high-income countries, women experiencing unexpected complications in early pregnancy attend an acute care service, such as an emergency department, rather than a maternity or obstetric unit. This service structure can impact the care women receive, and determine who provides it. Women and their partners, who are often experiencing emotional distress, have reported difficult experiences when accessing acute services, particularly emergency departments, which are not traditionally staffed by midwives. The role and scope of practice of both midwives and registered nurses providing acute early pregnancy care in most high-income countries, including Australia, is poorly reported. Documenting this area of practice is an important first step in facilitating ongoing research in this important aspect of pregnancy care. Published and gray literature that described the role and scope of practice of midwives and/or registered nurses providing care in acute early pregnancy settings in Australia were considered for this review. A scoping review of the literature was conducted following JBI methodological guidance and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. A 3-step search strategy was conducted to explore evidence from databases and search engines, gray literature sources, and selected reference lists. After screening, data were extracted from records selected for the final review, mapped, and analyzed using content analysis. The evidence reviewed (n=23) included primary research studies, conference abstracts, and gray literature, such as clinical guidance documents, academic theses, and websites from January 2008 to October 2023. The most common setting for care provision was the emergency department. Midwives' and registered nurses' roles and scope of practice in acute early pregnancy care in Australia can be summarized into 4 areas: physical care, psychosocial support, care co-ordination, and communication. Women's access to midwifery care at this time in pregnancy appears to be limited. Registered nurses, usually employed in emergency departments, have the most prominent role and scope in the provision of care for women with acute early pregnancy complications. Descriptions of midwives' practice focuses more on psychosocial support and follow-up care, particularly in early pregnancy assessment service models. This review highlights the inconsistency in midwives' and registered nurses' roles and scope in acute early pregnancy in Australia, a finding which is relevant to other international settings. Both professions could further fulfill role and scope capacity in the provision of supportive, individualized, and timely care for women and families accessing a range of acute early pregnancy services. Emergency departments are the usual practice domain of registered nurses who may be limited in terms of the scope of care they can provide to women with early pregnancy complications. Leaders of the midwifery profession should conduct further research into innovative service models that embed a role for midwives in all settings that provide care for pregnant women, regardless of gestation. Open Science Framework osf.io/7zchu.

Service Model for Women's and Children's Violence Victims of Collaborative Governance and Delivery Service

Purpose: This research aims to determine the Model of Assistance Services for Victims of Violence against Women and Children Based on Collaborative Governance and Delivery Service in the Musi Banyuasin Resort Police Crime and Investigation Unit. Method: This research uses qualitative research. The data sources in this research are Primary Data obtained from respondents' answers during interviews and Secondary Data obtained from documentation at the Women and Children Services Unit (PPA) of the Musi Banyuasin Resort Police Crime and Investigation Unit. Data collection techniques in this research use library studies and field research, and data analysis techniques in this research consist of data collection, data reduction, data presentation, and drawing conclusions and verification. Result and Discussion: The results of this research show that the service methods implemented to help victims of violence against women and children in the Musi Banyuasin Resort Police Criminal and Investigation Unit have been effective. They have provided various ways for the public to report problems and request consultation. Meanwhile, in Musi Banyuasin Regency, there are still several weaknesses in running this service even though it generally runs well. Research also suggests that the best way to assist women and child victims of violence is through close collaboration between the government and service providers, as implemented in the counseling program called Si Mapan. Implication of the Research: This research provides a better understanding of how support services for victims of violence against women and children can be improved through a collaborative approach to governance and service delivery. This can guide authorities in developing policies and practices related to the protection of women and children victims of violence in Musi Banyuasin Regency and possibly elsewhere. Originality/Value: This research is valuable because it introduces a new approach to assistance services for victims of violence against women and children, focusing on collaboration in government and service delivery (collaborative governance and service delivery).

Land scale division and multifunctional evaluation for Fuping County, China, based on DEM-based watershed analysis.

Land is the spatial background and basic carrier of human survival and development. The study of land function evaluation at different scales can promote the harmonious coexistence of humans and nature. Taking Fuping County, Hebei Province, China, as an example, this study establishes the theoretical framework of county-level land scale division using a digital elevation model (DEM)-based watershed analysis method and establishes the theory and methodological system of land function evaluation from the perspective of the characteristic scale. The multifunctionality of the land was evaluated using the Carnegie-Ames-Stanford approach (CASA), the Integrated Valuation of Ecosystem Services and Trade-offs (InVEST) model and comprehensive index evaluation. By using the methods of DEM-based watershed analysis, dominant factor differentiation and layer superposition, a three-level scale system of 'subwatershed scale-land chain scale-land segment scale' and a multifunctional multiscale evaluation index system containing 18 evaluation indices were established. The single-function and multifunction evaluation results of land at different scales were obtained by the comprehensive index method and Getis-Ord Gi* index method. The accuracy of land function evaluation results mainly depends on the selection of the measurement scale. The land measurement scale determined by DEM-based watershed analysis is close to the intrinsic scale of land function evaluation. The scale effect of land function in different temporal and spatial ranges is also evident and shows obvious spatial heterogeneity and difference. At larger scales, individual functions show synergistic effects.

Cloud service models, business continuity and disaster recovery plans, and responsibilities

Purpose The purpose of this article is to identify the role of cloud computing services in business continuity and disaster recovery plans and delineate responsibilities for their execution. In recent times, there has been a huge upsurge in the usage of cloud service models such as infrastructure-as-a-service, platform-as-a-service, software-as-a-service and disaster recovery-as-a-service. However, in case of an emergency event or during contract negotiations, a question might arise as to who should be accountable and responsible for the content and execution of recovery plans. The main stakeholders in this scenario are cloud service providers and cloud consumers. Design/methodology/approach After a review of academic articles, standards, guidelines and vendor documentation, a proposal for assigning accountability and responsibility for business continuity and disaster recovery plans is presented, based on the RACI (responsible, accountable, consulted and informed) matrix. In this regard, a critical information infrastructure protection plan, a disaster recovery plan, an information systems contingency plan and a business continuity plan have been elaborated on in the article. Findings RACI matrices are presented for three general cloud service models and for three DRaaS models (managed, assisted and self-service). Accountability and responsibilities depend on the deployed cloud service model and the roles of cloud service providers and cloud consumers. Originality/value The proposed model for accountability and responsibility assignment provides a guideline for the allocation of responsibilities to roles not only during recovery but also during contract negotiations between cloud service providers and cloud consumers. By delving into business continuity and disaster recovery processes and activities, similar yet nuanced RACI matrices should be developed, as presented in this paper. They need to be customised for the specific context.

Understanding Women’s Preferences for Prevention of Mother-to-Child HIV Transmission Services in Kenya

Background and Objective Understanding the preferences of women living with HIV (WLH) for the prevention of mother-to-child HIV transmission (PMTCT) services is important to ensure such services are person-centered. Methods From April to December 2022, we surveyed pregnant and postpartum WLH enrolled at five health facilities in western Kenya to understand their preferences for PMTCT services. WLH were stratified based on the timing of HIV diagnosis: known HIV-positive (KHP; before antenatal clinic [ANC] enrollment), newly HIV-positive (NHP; on/after ANC enrollment). Multivariable logistic regression was used to determine associations between various service preferences and NHP (vs. KHP) status, controlling for age, facility, gravidity, retention status, and pregnancy status. Results Among 250 participants (median age 31 years, 31% NHP, 69% KHP), 93% preferred integrated versus non-integrated HIV and maternal-child health (MCH) services; 37% preferred male partners attend at least one ANC appointment (vs. no attendance/no preference); 54% preferred support groups (vs. no groups; 96% preferred facility – over community-based groups); and, preferences for groups was lower among NHP (42%) versus KHP (60%). NHP had lower odds of preferring support groups versus KHP (aOR 0.45, 95% CI 0.25–0.82), but not the other services. Conclusion and Global Health Implications Integrated services were highly preferred by WLH, supporting the current PMTCT service model in Kenya. Further research is needed to explore the implementation of facility-based support groups for WLH as well as the reasons underlying women’s preferences.

Green Cloud Computing: Innovating for Sustainable, Low-Impact Data Management.

Cloud computing is the internet-based provision of computer services. The usage of some cloud services by individuals and businesses is expanding quickly. The rising demand for cloud infrastructure has led to a notable rise in the energy consumption of data centers. Reducing energy usage is essential to lowering carbon dioxide emissions, hence it must be addressed. Given that green cloud computing's main objective is to maximize energy efficiency, it is acknowledged as a potential solution to this issue. This paper presents green cloud computing alternatives for energy savings in addition to defining cloud computing with the key cloud service models, deployment strategies, and computing platforms. After that, these solutions were categorized based on how well they reduced energy.

A new service composition method in the cloud‐based Internet of things environment using a grey wolf optimization algorithm and MapReduce framework

SummaryCloud computing is quickly becoming a common commercial model for software delivery and services, enabling companies to save maintenance, infrastructure, and labor expenses. Also, Internet of Things (IoT) apps are designed to ease developers' and users' access to networks of smart services, devices, and data. Although cloud services give nearly infinite resources, their reach is constrained. Designing coherent and organized apps is made possible by integrating the cloud and IoT. Expanding facilities by combining services is a critical component of this technology. Various services may be presented in this environment based on the user's demands. Considering their Quality of Service (QoS) attributes, discovering the appropriate available atomic services to construct the needed composite service with their collaboration in an orchestration model is an NP‐hard issue. This article suggests a service composition method using Grey Wolf Optimization (GWO) and MapReduce framework to compose services with optimized QoS. The simulation outcomes illustrate cost, availability, response time, and energy‐saving improvements through the suggested approach. Comparing the suggested technique to three baseline algorithms, the average gain is a 40% improvement in energy savings, a 14% decrease in response time, an 11% increase in availability, and a 24% drop in cost.

Non-trade-off Changes in Soil Conservation Service and Soil Loss on the Tibetan Plateau Underlying the Impacts of Climate Change and human activities.

Climate change and human activities have significantly influenced soil loss and the soil conservation service, posed threats to regional ecological sustainability. However, the relationships and underlying driving forces between potential soil loss, actual soil loss, and soil conservation service have not been well understood. Utilizing the Integrated Valuation of Ecosystem Services and Trade-offs (InVEST) model, we evaluated the soil conservation service on the Tibetan plateau from 1990 to 2020. We analyzed the spatial and temporal trends and examined the driving factors using linear regression, Pearson correlation, and random forest regression. The soil conservation service exhibited a complex pattern of increase followed by a decrease, with a turning point around 2010. Soil conservation service and soil loss demonstrated non-trade-off changes. The potential soil loss dominated the spatiotemporal patterns of soil conservation service on the Tibetan Plateau. Climatic factors significantly influenced the spatiotemporal patterns of soil conservation service, with annual precipitation emerging as the dominant driving factor, contributing approximately 20%. However, the impacts of human activities became more pronounced since 2010, and the contribution of vegetation to changes in soil conservation service was increased. The impact of the Normalized Difference Vegetation Index (NDVI) on soil conservation service for the grades I, II, and III increased by 13.19%, 3.08%, and 3.41%, respectively. Conversely, in northern Tibet before 2010 and eastern Three-River-Source after 2010, soil conservation service exhibited an increasing trend driven by both climate factors and human activities. Which indicates that the implementation of ecological restoration measures facilitated vegetation improvement and subsequently reduced actual soil loss. This study provides a scientific basis for resource management, land development strategies, and the formulation of ecological restoration measures on the Tibetan Plateau.

LITERATURE REVIEW: MODEL CONTINUITY OF CARE PELAYANAN KEBIDANAN DEPRESI POSTPARTUM

During the postpartum period, midwives not only assess the physical examination and breastfeeding process, but also must assess the emotional well being and social support of the postpartum mother. The Continuity of Care (CoC) midwifery care model makes mothers get to know their caregivers better, this is one of the midwifery care models that provides services to help women build relationships with their caregivers. Postpartum depression is a major health problem, having a dangerous impact on postpartum mothers, their babies, and their families. The prevalence of depression in the Southeast Asia region is 27%, while in Indonesia the prevalence of depression is 3.7% and ranks second after India at 4.5%. This study aims to determine the Continuity of Care model for midwifery services with postpartum depression. The type of research used in this research is literature review research using 5 journals from the sources used in the form of journal search studies in electronic databases such as the Directory of Open Access Journals (DOAJ), ScienceDirect and EBSCO in full text form. So it can be concluded that a strong relationship between mothers and midwives who are known for providing continuous care, results in increased trust, more personal and loving care, and better sharing of information will reduce postpartum depression. To address knowledge gaps and methodological deficiencies in the existing literature, articles on postpartum depression in Asian countries need to further explore the role of physical, biological and cultural factors.

Coconstructing a Flexible At-Home Respite Model For and With Caregivers of Older Adults: A Living Lab Approach

At-home respite services seem too rigid to meet the needs of older adults and their caregivers. It is critical to develop service flexibility, as it allows for personalized care, adapted to health conditions, preferences, and evolving needs. While no prior studies used coconstruction methods to increase flexibility, this study could offer a better understanding of flexible respite for stakeholders. Using a living lab approach, this article aimed to (1) empirically determine the characteristics of this type of respite model and (2) document the levers and obstacles to consider for its implementation. Starting from a pre-existing flexible respite model named ANAAIS, the research team led workshops and interviews. First, the team carried out 2 workshops (TRIAGE and persona-scenario) with a total of 3 caregivers and 8 homecare professionals or managers. Second, a team member conducted interviews with 3 caregivers and 6 homecare professionals or managers. Content analysis was used on the data. The stakeholders coconstructed a Québec version of ANAAIS, a web application allowing caregivers to request an affordable respite, at the time wanted, and offered by a qualified care worker, through a simple application. Levers and barriers to its deployment are linked to the model’s characteristics as well as its internal and external context. For example, relations and connexions were perceived as a lever to deployment, while the lack of resources was considered an obstacle. This living lab project showed the feasibility and pragmatism of coconstructing a flexible and applicable respite service model.

Utilization of Kombucha Tea to Improve Children's Health and Reduce Stunting Rates in Patempuran Village, Jember Regency

In order to overcome the problem of stunting in children, a team of Jember University lecturers collaborated with the Patempuran Village community and posyandu cadres to carry out community service activities. The main focus of this activity is the mass use and dissemination of Kombucha Tea, chosen because of its important nutritional content and potential to improve intestinal health and nutrient absorption in children. This activity includes outreach to increase understanding of the benefits of Kombucha Tea, training for posyandu cadres and village mothers on how to produce Kombucha Tea, as well as the distribution process to families with children under five. Apart from that, counseling regarding healthy eating patterns and the importance of nutrition was also provided in this activity. The impact evaluation was carried out after the activity was carried out to measure the extent to which Kombucha Tea made a positive contribution in reducing stunting rates in Patempuran Village. Close collaboration between the lecturer team, the community and the local government forms a sustainable community service model, which is expected to have a positive impact in improving the welfare of children in Patempuran Village.

Low selection of HIV PrEP refills at private pharmacies among clients who initiated PrEP at public clinics: findings from a mixed-methods study in Kenya

BackgroundIn Africa, the delivery of HIV pre-exposure prophylaxis (PrEP) at public healthcare clinics is challenged by understaffing, overcrowding, and HIV-associated stigma, often resulting in low PrEP uptake and continuation among clients. Giving clients the option to refill PrEP at nearby private pharmacies, which are often more convenient and have shorter wait times, may address these challenges and improve PrEP continuation.MethodsThis mixed methods study used an explanatory sequential design. At two public clinics in Kiambu County, Kenya, clients ≥ 18 years initiating PrEP were given the option to refill PrEP at the clinic where they initiated for free or at one of three nearby private pharmacies for 300 Kenyan Shillings (~ $3 US Dollars). The providers at these pharmacies (pharmacists and pharmaceutical technologists) were trained in PrEP service delivery using a prescribing checklist and provider-assisted HIV self-testing, both with remote clinician oversight. Clients were followed up to seven months, with scheduled refill visits at one, four, and seven months. The primary outcomes were selection of pharmacy-based PrEP refills and PrEP continuation. Following pilot completion, 15 in-depth interviews (IDIs) with clients who refilled PrEP were completed. We used descriptive statistics and thematic analysis to assess study outcomes.ResultsFrom November 2020 to November 2021, 125 PrEP clients were screened and 106 enrolled. The majority (59%, 63/106) of clients were women and the median age was 31 years (IQR 26–38 years). Over 292 client-months of follow-up, 41 clients (39%) refilled PrEP; only three (3%) at a participating pharmacy. All clients who completed IDIs refilled PrEP at clinics. The reasons why clients did not refill PrEP at pharmacies included: a preference for clinic-delivered PrEP services (i.e., pre-existing relationships, access to other services), concerns about pharmacy-delivered PrEP services (i.e., mistrust, lower quality care, costs), and lack of knowledge of this refill location.ConclusionsThese findings suggest that clients who initiate PrEP at public clinics in Kenya may have already overcome barriers to clinic-delivered PrEP services and prefer PrEP access there. To reach new populations that could benefit from PrEP, a stand-alone model of pharmacy-delivered PrEP services may be needed.Trial registrationClinicalTrials.gov: NCT04558554 [registered: June 5, 2020].

Establishing a telehealth model addressing paediatric sleep health in remote and rural Northern Territory Australia: Overcoming the distance barrier.

This study examined the outcomes of a telehealth model for sleep health assessment among Indigenous and non-Indigenous children residing in remote and regional communities at the Top End Northern Territory (NT) of Australia. Video telehealth consultation, that included clinical history and relevant physical findings assessed virtually with an interstate paediatric sleep physician was conducted remotely. Polysomnography (PSG) and therapeutic interventions were carried out locally at Darwin, NT. The study participants were children referred between 2015 and 2020. Of the total 812 children referred for sleep assessment, 699 underwent a diagnostic PSG. The majority of patients were female (63%), non-Indigenous (81%) and resided in outer regional areas (88%). Indigenous children were significantly older and resided in remote or very remote locations (22% vs. 10%). Referral patterns differed according to locality and Indigenous status - (non-Indigenous via private (53%), Indigenous via public system (35%)). Receipt of referrals to initial consultation was a median of 16 days and 4 weeks from consult to PSG. Remote children had slightly longer time delay between the referral and initial consult (32 vs. 15 days). Fifty one percent were diagnosed to have OSA, 27% underwent adenotonsillectomy and 2% were prescribed with CPAP therapy. This study has demonstrated that a telehealth model can be an effective way in overcoming logistical barriers and in providing sleep health services to children in remote and regional Australia. Further innovative efforts are needed to improve the service model and expand the reach for vulnerable children in very remote communities.