Survey Participants Research Articles

Effectiveness of Experiential Learning Approaches (ELA) in enhancing students’ active participation in physical education

Background: Active participation in physical education (PE) is essential for students’ development yet remains challenging in many schools. Research Objectives: This study aimed to assess the effectiveness of experiential learning approaches, including role-playing and interactive simulations, in enhancing students’ willingness and ability to actively participate in PE at Gabas Integrated School (GIS). Methods: This study utilised a one-group pretest-posttest design in which 34 Grade 9 GIS students participated. A researcher-made survey questionnaire patterned from the Students’ Participation Survey and the Motivation in Physical Education Survey and a checklist tool were used to gather data. Education experts reviewed the survey questionnaire to ensure content validity and conducted a pilot test. The collected data were analysed using Jeffrey’s Amazing Statistics Program (JASP). Findings/Results: The study revealed that the students’s willingness to participate was initially moderately willing, which increased to extremely willing after the intervention. The student’s ability to participate improved from a participative rating to a highly participative rating after the intervention. The Wilcoxon signed-rank test further revealed significant differences between the students’ willingness and ability to participate before and after the intervention. Conclusion: These findings concluded that an experiential learning approach effectively enhances students’ active participation in terms of their willingness and ability to participate in PE classes. Thus, the Department of Education must encourage teachers to use ELA to transform students from passive spectators to active participants. Physical education teachers must also consider incorporating performance-based learning and real-life scenarios that allow students to apply their skills in meaningful contexts to their physical education teaching.

Student Perceptions of ChatGPT in Mandatory EFL Writing Classes at a Korean University : A Case Study

This study explored to what extent students at a Korean university perceive ChatGPT as useful in mandatory university EFL writing classes. In addition, preferences regarding methods of instruction and the outlook for future classes of a similar nature in the era of ChatGPT were also examined. 239 students enrolled at a university located on the outskirts of Seoul responded to a survey questionnaire consisting of a combination of multiple choice, 10-point Likert scale, and open-ended questions, which was used as the primary data collection method. Data analysis was conducted using general qualitative analysis for open ended questions and descriptive statistics for multiple choice and 10-point Likert scale questions. In addition, if consent was given, survey participants were contacted by e-mail to discuss responses in further detail. Despite concerns relating to ownership of learning and overreliance, the findings indicate generally positive perceptions of ChatGPT in terms of assisting with grammar, vocabulary, brainstorming, and proofreading. Conventional approaches (e.g., human teacher, in person lessons, and inter student / teacher communication) are still highly desired although the increasing influence of ChatGPT cannot be ignored. There is a belief that mandatory EFL writing classes currently play a vital role at Korean universities, and there is a strong preference for them to continue. Administrational and educational implications are also discussed.

Data-driven development and validation of a nutrient-based score to measure nutritional balance of meals in the Philippines

BackgroundThe goal of the present study was to design an easily computable score, based on nutrient composition data instead of food groups, to evaluate the nutritional quality and balance of meals, adapted to the nutritional recommendations for Filipino adults.MethodThe score was defined as a weighted average of 9 nutrient scores. Protein, total fat, saturated fat, free sugars were scored as % of energy; calcium, fiber, sodium, vitamin C, magnesium were scored based on the local dietary reference intakes. The scoring algorithm was an adaption of a score previously developed by the authors based on US data. In the present study, the score was applied to 69,923 meals reported by 31,218 adult Filipinos aged 20 to 59 in the 2018 edition of the Philippine Expanded National Nutrition Survey to evaluate its validity and compare against exemplary meals designed as part of 24 h diet plans that meet local dietary guidelines.ResultsMeals from these exemplary menu plans, developed by local nutrition experts, scored on average 72.2 ± 13.9 (mean ± standard deviation) while those of survey participants scored 46.1 ± 12.9. Meal scores were significantly associated with the density of positive micronutrients (e.g., Vit A, Vit C) and favourable food groups (e.g. fruits, whole grains) not directly included in the algorithm.ConclusionThe score, between 0 and 100, is a valid tool to assess the nutritional quality of meals consumed by the PH population, accounting for both shortfall and excess nutrients, adjusted for the energy content of the meal. If applied to consumer-facing applications, it could potentially help users to understand which meals are nutritionally balanced.

Unmasking population undercounts, health inequities, and health service access barriers across Indigenous populations in urban Ontario.

Our Health Counts (OHC) methods are designed to address gaps in urban-based Indigenous health information. In partnership with local Indigenous health service providers, we have successfully implemented OHC in six Ontario cities. The aim of this study is to summarize findings regarding Indigenous population undercount, health inequities, and health service access barriers across study sites. We estimated Indigenous population size using OHC census participation survey responses and a multiplier approach. Health inequities between Indigenous populations and overall populations in each city were examined using respondent-driven sampling (RDS), adjusted OHC survey results, and existing public data. Measures included health status outcomes; determinants of health; barriers to health service access, including discrimination by health service providers; and unmet health needs. Indigenous social networks were strong and extensive, and the urban populations demonstrate resilience and cultural continuity across multiple measures. Self-reported rates of census participation for Indigenous populations were markedly lower than those for the general population in each city, and OHC Indigenous population size estimates were consistently 2‒4 times higher than reported in the census. Indigenous to general population health inequities cut across measures of chronic disease, determinants of health, and unmet health needs. Indigenous populations experienced multiple barriers to health services access, including racial discrimination by health service providers. The Canadian census appears to markedly underestimate Indigenous population size in urban areas. Indigenous health inequities and service access barriers are striking and cross-cutting. Timely adaptation of health policies, services, and funding allocations in response to these findings is recommended.

Access to transition-related health care among transmasculine people in India: A mixed-methods investigation.

Little research has examined the health care experiences of transmasculine people in India, where government initiatives to improve access to transition-related (also called gender-affirmative) care have recently been announced. We draw on data from 'Our Health Matters', a mixed-methods community-based participatory research project, to characterize the transition-related care experiences of transmasculine people in India. Peer researchers conducted 40 virtual qualitative interviews in Hindi or Marathi from July to September 2021. Between November 2022 and January 2023, 377 transmasculine people participated in a multi-mode survey available in five languages. Qualitative data were analysed with a combination of framework analysis and grounded theory techniques. Data were mixed using a convergent parallel approach. Transmasculine persons' care journeys began with information-seeking, relying on peers and internet searches. In choosing between the public and private healthcare systems, they weighed issues of quality and affordability: the public system was perceived as lower-quality and difficult to access but most could not afford private care, leading to delays in care. Indeed, unmet need was common; 36.4% of survey participants were planning but had not begun to receive transition-related care and 80.2% wanted at least one transition-related surgery. Although some participants encountered stigma and refusal of care when seeking hormones, survey participants reported largely positive experiences with their hormone prescribers, which may reflect the influence of peer referrals. Participants underwent psychological assessments prior to transition-related care, which some experienced as disempowering and a barrier to disclosing mental health challenges. Finally, participants who were able to access care reported improved well-being, although surgical dissatisfaction was not uncommon (26.2%). Trans-inclusive medical training and continuing education are critical to enhancing access to high-quality transition-related care. Transmasculine people generally relied on peers and grassroots organizations for information, system navigation, and financial assistance. Strengthening these existing community resources may improve access to care.

Attitudes, Beliefs, and Self-Reported Rates of Influenza and COVID-19 Vaccinations in the Canadian 2023–2024 National Influenza and Respiratory Viruses Survey

Background: We conducted a cross-sectional, online survey of adult Canadian residents to evaluate their attitudes and beliefs about vaccination against respiratory viruses, particularly influenza and coronavirus 2019 (COVID-19). Methodology: Survey participants aged ≥ 18 years were randomly recruited from the Léger Opinion (LEO) consumer panel. Results: Out of 3002 respondents, 76% reported being “up-to-date” on all of their recommended vaccinations, 86% reported understanding why the influenza vaccine was needed annually, 79% reported believing the influenza vaccine was safe, and 83% reported understanding that vaccines, in general, were important for health. However, only 49% reported receiving the influenza vaccine in the fall of 2023, and 46% received a COVID-19 vaccine (68% of those who received one received the other). More than half of the respondents (55%) reported that they found it difficult to keep track of which vaccines were recommended for them, while 74% indicated that they valued the opinion of their healthcare provider (HCP) when deciding whether to be vaccinated against influenza, and 73% said they would not hesitate to receive multiple vaccines at the same time if their HCP recommended it. Conclusions: These findings highlight the ongoing need for education and outreach in Canada.

Understanding Reasons for Participation and Barriers Within Adaptive Sports for Individuals with Physical Disabilities

The importance of participating in physical activity is widely advocated to reduce diseases, especially for individuals with physical disabilities. Adaptive sports have shown a multitude of benefits for those with physical disabilities, but few researchers have determined the benefits of adaptive sports from the perspective of the athletes. The purpose of this research study was to explore (1) reasons that individuals with physical disabilities engage in adaptive sports and (2) why individuals with physical disabilities do not participate in adaptive sports. Using an ethnographic qualitative retrospective design, 104 participant survey and phone interview responses were analyzed. Four themes emerged for reasons for adaptive sports participation including three subthemes, and five themes for barriers to adaptive sports participation. Applications for practice will be discussed for practitioners working with individuals who engage in adaptive sports will be identified.

Workers’ experiences of pregnancy loss: qualitative insights from a mixed-methods study

Abstract Background Pregnancy loss affects approximately one in four pregnancies. The workplace is an important context to consider in pregnancy loss experiences as most women of reproductive age are in paid employment. Currently in the Republic of Ireland (ROI) there are no statutory leave entitlements if a pregnancy ends <24 weeks. Given the lack of research in this area internationally, we aimed to explore workplace experiences of early pregnancy loss. Methods In 2023, we conducted an online mixed-methods survey study (Mar-Apr), followed by qualitative interviews (Jun-Sept). People who experienced a pregnancy loss <24 weeks-whilst working and living in ROI in the preceding five years-were eligible to participate. The survey was distributed through professional/social networks and contained quantitative and qualitative questions-addressing pregnancy loss, experiences of workplace supports, and desired supports. Survey participants were asked to indicate their willingness to participate in a follow-up interview and were purposively sampled. The interview topic guide focused on specific aspects of workplace experiences which required further exploration following preliminary analysis of survey responses. Qualitative data were analysed in NVivo using reflexive thematic analysis. Results Most survey participants (N = 913) were female (74%), employed full-time (86%) and experienced a first-trimester miscarriage (75%). We conducted interviews with 13 people, across a range of demographics. Three initial themes were identified: (1) Personal experiences of pregnancy loss and dealing with emotional and physical impacts at work; (2) Challenges with the social side of pregnancy loss-disclosure and workplace interactions; (3) Workplace supports (4) Public policy and awareness. Conclusions Our analysis highlights the need for statutory leave, appropriate workplace policies and procedures, and education and training to better support workers who experience pregnancy loss. Key messages • There is a gap between workers’ needs and workplace supports regarding pregnancy loss <24 weeks gestation. Statutory leave, workplace policies and procedures, and education and training, are needed. • There is a need to discuss pregnancy loss in workplaces and society, to raise awareness and reduce the stigma/taboo on the topic. Recognition from Government is crucial to promote this.

Does individualism lead to longer working hours?

AbstractObjectiveIn this article, utilizing the European Social Survey (ESS), we empirically analyze the effect of individualism on working hours at the micro level.MethodWe use the European Social Survey (ESS), which is a biennial survey conducted in European countries. The ESS provides us five different proxies to measure individualism. In our empirical analyses, we first use proxies separately as our measure of individualism in the regressions. Second, we create a composite indicator for individualism by using the principal component analysis (PCA). We use two different methods for polychoric PCA.ResultsIn four of our individualism proxies, we find that individualism is positively and significantly associated with working hours. Our PCA results also show that survey participants with higher individualistic attitudes tend to work longer hours.ConclusionWe find robust empirical evidence that people who place greater emphasis on individualistic values have a tendency to work longer. The results show that individuals who give more importance to money, expensive things, success, recognition of achievements, showing abilities and being admired, and freedom on his/her decisions are inclined to work longer hours.

Health symptoms in individuals with and without post-covid in the Dutch general population

Abstract Background Health symptoms, often non-specific in nature such as headache and sleep problems, are more prevalent in the aftermath of disasters. Relatively little research focused on non-specific symptoms in the context of the COVID-19 pandemic, including those with post-covid conditions. The aim of this study was to assess the symptomatic profile of people with post-covid conditions, and to assess differences in health symptoms between non-infected individuals, infected individuals, and individuals with post-covid. Methods A nation-wide cross-sectional health survey performed in 2022 was combined with routine primary care electronic health records (EHRs). Prevalence of individual symptoms was analyzed, as well as symptom scores for number, duration, and severity of symptoms. The total survey sample consisted of 315,586 individuals. The EHR sample consisted of 29,797 individuals with matched survey data. Both samples were divided into three groups: non-infected, infected, and post-covid. Results Survey participants with post-covid experienced significantly (CI 99%) more (incidence risk ratio (IRR) 1.55), longer lasting (IRR 1.87), and more severe self-reported symptoms (IRR 1.95) compared to non-infected individuals. For infected compared to non-infected survey participants, there were hardly differences in symptom scores. The most distinct differences in individual symptoms were observed for loss of smell or taste, fatigue, and respiratory problems. Based on EHR data, the post-covid group is at significantly higher risk of experiencing fatigue, shortness of breath, headache, sleep problems, and dizziness. Conclusions Individuals suffering from post-covid are at the highest risk of experiencing health symptoms, both based on self-reported symptoms as well as based on EHRs. The infected group generally experienced more self-reported symptoms than the non-infected, but on average, they experienced them at a shorter duration, and they also reported them to be less severe. Key messages • Health symptom prevalence is higher in individuals with post-covid in the Netherlands. • This effect is confirmed in self-reported health surveys as well as in primary care registries.

Duties, tasks, knowledge and skills of an obesity medicine physician: A practice analysis

BackgroundGiven the evolving nature of obesity medicine, periodic evaluation of its clinical practice is needed to ensure that certification requirements address real-world experience. Practice analysis is a systematic approach to define a field's body of knowledge, and its results can inform the content outline and examination blueprint for a certification examination. This study describes the 2023 practice analysis conducted by the American Board of Obesity Medicine (ABOM). MethodsInitially, 14 obesity medicine physicians participated in a practice analysis panel, resulting in 3 duties and 30 tasks required for competent practice of obesity medicine physicians. Each task included steps, knowledge, skills, and abilities needed to perform the task. ABOM then recruited 645 certified obesity medicine physicians from its database to participate in a validation survey to rate the frequency [scale: never (0) to very frequently (5)] and importance [scale: not important (0) to very important (3)] of each task. Survey participants could also provide open-ended comments. ResultsAmong validation survey participants (n = 645), the most common primary medical specialties reported were internal medicine (46.0 %), family medicine (33.8 %), and pediatrics (11.2 %). Years practicing obesity medicine varied with 45.3 % reporting 1–4 years, 26.0 % 5–9 years, and 28.7 % ≥ 10 years in practice. Most tasks were performed frequently (mean score ≥4.0) and rated as important (mean score ≥2.0). All tasks were retained based on the frequency and importance ratings. Survey results informed the weighting in the examination blueprint. ConclusionThere was consensus among practicing ABOM-certified physicians who participated in the validation survey in the tasks required for competent obesity medicine practice. Our practice analysis approach was a structured process that engaged obesity medicine physicians and captured the breadth and depth of knowledge required for obesity medicine. The new content outline and examination blueprint developed will be implemented with the 2025 ABOM certification exam administration.

Harming the innocent: estimating the number of children affected by parental problem gambling

Abstract Background The impact of parental problem gambling on children and adolescents encompasses negative outcomes in psychological, financial, behavioral, physical health, and family relationship domains. For Germany, estimates on the number of co-affected minors are lacking. Methods Within the population-representative Germany-wide “Glücksspielsurvey 2023” (i.e., “Gambling Survey 2023”), we assessed parenthood in survey participants with gambling disorder (GD; according to DSM-5) as well as the number of minors (age <18 years) living a) together with a person with gambling disorder (shared household) or b) apart from a parent with gambling disorder (separate household). Using a “minimum maximum approach,” we performed a weighted extrapolation to estimate the number of co-affected minors in the German resident population (range 18 to 70 years of age) and the prevalence of parental GD among Germany-residing minors. Results 46.8% (n = 132) of survey participants with GD report shared households with minors and 16.3% (n = 46) separate households. The average number of minors concerned was 1.55 (SD = 0.07) in shared and 1.51 (SD = 0.13) in separate households. This translates into 480,294 to 701,766 co-affected children in shared households (3.4% to 4.9% of Germany-residing minors) and 91,742 to 124,618 co-affected children in separate households (0.6% to 0.9% of Germany-residing minors). Discussion and conclusions Taking shared and separate households into account, one in 20 Germany-residing minors is co-affected by parental GD. Acknowledging that impaired psychosocial wellbeing in the context of parental GD could persist into adulthood of co-affected minors, this issue ought to be recognized as a major public health concern. To reduce related harm, children of people with GD should be best possibly integrated into the care process by offering additional help and support strategies explicitly addressed at this vulnerable population. Key messages • Parental problem gambling significantly impacts a substantial portion of German minors, with approximately one in 20 being affected, highlighting the urgent need for attention to this issue. • Recognizing parental gambling’s long-term impact on minors, it’s crucial to implement support strategies in care to address their needs effectively.

Social disconnectedness and the rate of medical conditions: a Danish population-based cohort study

Abstract Background Lack of social connections has a serious impact on health, increasing the risk of medical conditions such as depression, dementia, and coronary heart disease. However, evidence is limited by a disease-specific focus. We aimed to provide a comprehensive overview of differences in incidence rates of a broad range of medical conditions according to social disconnectedness (i.e., loneliness, social isolation, and low social support). Methods We conducted a cohort study using data on loneliness, social isolation, low social support, and a composite measure from the 2013 and 2017 Danish National Health Survey. Survey data was linked with register data on 11 categories of medical conditions through 2021. Poisson regression was applied to estimate incidence rate ratios (IRRs), incidence rate differences, and explore interaction with pre-existing mental disorders. Results Among 162,497 survey participants, 7.6%, 3.5%, and 14.8% were identified as lonely, socially isolated, and with low social support, respectively. Lonely individuals and individuals with low social support had a higher incidence rate of all 11 categories of medical conditions (interquartile range of IRRs, loneliness 1.22-1.49 and low social support 1.10-1.14), whereas this was the case for nine categories among socially isolated individuals (interquartile range of IRRs, 1.01-1.31). Applying the composite measure, the highest IRR was 2.61 (95% CI, 2.34-2.88) for a mental disorder and the lowest 1.03 (95% CI, 0.95-1.10) for cancer. We found neither major sex differences nor substantial interaction with pre-existing mental disorders. Conclusions Our study confirms and extends the available evidence on social disconnectedness and the risk of medical conditions. The attained knowledge may be of significance for mapping group-specific preventative needs and guiding interventions and health practitioners aiming to reduce the disease burden among socially disconnected individuals. Key messages • Based on survey and register data from 162,497 individuals, our study suggests that social disconnectedness, especially loneliness, is a determinant of a broad range of medical conditions. • The findings may be of importance for identifying and targeting the disease burden among socially disconnected individuals.

Digital divide in access and use of digital health technologies: what do we know from Germany?

Abstract Even though Germany is an industrialised country, health inequalities exist between individuals or population groups due to unequal access to scarce social resources such as money or knowledge. This case study illustrates the extent of the digital divide in access and use of digital health technologies. Data from the Liter@te study, in which 96 adults aged 18-64 years with low reading and writing skills living in Germany were asked about their digital health technology use and their digital health literacy, were compared with two parallel conducted population surveys in Germany (i.e., nationwide telephone survey on digitalisation and health with 1020 internet users aged 18 years and above, online survey on digitalisation in health care with 1839 adults aged 18-80 years insured at a statutory health insurance company). Adults with low reading and writing skills used digital devices in the health context such as computers (23% vs. 71%) or activity trackers (21% vs. 35%) less frequently than the general population, whereas no differences were reported in the use of smartphones (79% vs. 70%). In addition, 18% of adults with low reading and writing skills and 4% of the general population stated that they do not use digital health technologies. Other digital health technologies such as online appointment scheduling (25% vs. 81%) or health websites (32% vs. 45%) were also used less frequently by adults with low reading and writing skills compared to the general population. Participants in the Liter@te study who do not use digital health technologies reported more frequent access problems (e.g., no suitable device, technical problems, poor internet connection) than participants in the population survey. 35% of participants in the Liter@te study have a low digital health literacy (eHEALS score between 8-19/40 points), compared to only 8% in the population survey.

Characteristics of web-based and paper-based respondents in The Danish Capital Region Health Survey

Abstract Background and aim This study aims to investigate the potential impact of adopting web-only surveys on the representativeness of survey participants by examining the sociodemographic characteristics of participants in the Danish Capital Region Health Survey (DCRHS) who respond online versus those who respond using a paper-based questionnaire. Methods The study utilizes data from the DCRHS including participants invited by a mixed-mode approach and given the choice to respond to a web-based or paper-based questionnaire in 2021 (N = 53,874) and 2017 (N = 51,902). Information on age and sex was obtained from national registers. Results The proportion of paper respondents decreased significantly from 18% in 2017 to 16% in 2021. In both years, women had higher odds of responding on paper compared with men (OR = 1.20; 95% CI: 1.16-1.24). In 2017, the highest prevalence of paper respondents was observed among participants aged ≥80 (29%) and 16-24 years (21%). In 2021, the highest prevalence was likewise observed among participants aged ≥80 (28%) but with the second highest among the 65-79 years age group (17%). The decrease in paper responses from 2017 to 2021 varied across age groups, with a greater decrease among younger participants than among older participants. Conclusions This study highlights the potential risk of excluding a significant proportion of elderly citizens from large population surveys if the web-based response option is the only option provided. Elderly individuals are less likely than younger individuals to switch to digital responses, emphasizing the importance of considering alternative modes of data collection to ensure representativeness in survey samples. Key messages • The use of web-only surveys has increased; however, we risk excluding a significant proportion of elderly citizens from large population surveys if only the web-based response option is provided. • Elderly individuals are less likely to switch to digital responses, emphasizing the importance of considering alternative modes of data collection to ensure representativeness in survey samples.

How factchecking organizations can partner within public health for a healthier internet

Abstract Background Health concerns, narratives and misinformation are growing in digital spaces, which makes them also a vulnerability to being hijacked by disinformation. A workshop was held at GlobalFact11, the global factchecking summit, to take a pulse among the participants on their exposure and work with health misinformation, provide a public health perspective on the role of factchecking, and equip participants with building a business case for developing health-related factchecking programmes. Methods A pre-summit survey of IFCN members and summit participants was conducted to better tune the design of the discussion in the workshop. The workshop included interactive polling and a discussion of case-based scenarios and real-world examples. Results A business case for investing into health-claim fact-checking can consider needs of public health organizations from a variety of perspectives. (1) The global health security agenda, and the politicization of health and hijacking in disinformation influence campaigns; (2) Contributing data for public health infodemic insights reports in formats that provide value to fact-checking in public health context; (3) Developing community resilience programmes by combining fact-checking with community-based interventions; (4) Building partnerships with public health organizations (for fact-checking, capacity building, community media and information literacy, research). Conclusions Many fact-checking organizations got involved in public health during the COVID-19 pandemic. However, they want to access more public health expertise, tools, and partnership modalities that would enable them a more sustainable effort in covering health topics, especially beyond infectious disease.

Alarm fatigue and sleep quality in healthcare workers

Abstract Background Alarm fatigue, a prevalent issue in medical settings, arises when healthcare professionals are exposed to an overwhelming number of clinical alarms, leading to desensitization and decreased responsiveness. The constant alertness required due to medical device alarms in hospitals can severely disrupt the quality of sleep for medical personnel. This study aims to demonstrate whether there is a relationship between alarm fatigue and sleep quality in medical staff. For the research project, it was decided to carry out the study in three European neighbouring countries: Poland, Slovakia and the Czech Republic Methods The the survey was carried out in three European countries: Poland, Slovakia, and the Czechia from June to July 2023. The study was attended by a total of 756 participants. The study used: a socio-demographic metric; Alarm Fatigue Assessment Questionnaire and The Pittsburgh Sleep Quality Index to evaluates sleep quality. Results Among the 756 survey participants, 603 (79.76%) had poor sleep quality (6-21 PSQI points), 147 (19.44%) had good sleep quality (0-5 PSQI points), and 6 (0.79%) did not answer. The analysis of sleep quality scores for participating countries shows that sleep problems were significantly higher in Slovakia and Poland than in the Czech Republic. Alarm fatigue levels were determined for respondents in every country in this study. The statistical difference between countries is significant. In Slovakia and Poland, the levels of alarm fatigue caused by medical devices were significantly higher than in the Czech Republic. With regards to sleep quality, there is a positive correlation between alarm fatigue and sleep problems. A statistically significant positive correlation was obtained for all three countries. Conclusions The study found that workers in the health system are exposed to alarm fatigue, and that this in turn can reduce sleep quality. The consequences of this may be reflected in patient safety. Key messages • The results of the study clearly indicate that quality of work should be ensured by developing protocols for managing medical device alarms. • Combatting alarm fatigue among medical personnel is vital for public health as it reduces medical errors caused by sleep deprivation.

The relationship between health literacy level and quality of life in bariatric surgery patients

Abstract Background Today, obesity is an important public health problem. In addition to the intervention programmes developed to prevent obesity, the necessity of medical and surgical treatment is increasing with the growing population. This study was conducted to determine the relationship between health literacy and quality of life in patients undergoing bariatric surgery. Methods This cross-sectional study was conducted with the participation of 136 patients aged 18 years and older who underwent bariatric surgery in a general surgery service between January 2021 and December 2023 and whose contact information was available. The survey participation rate was 75.1%. The questionnaire used for data collection consisted of questions about the sociodemographic information of the participants, The European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the Postbariatric Surgery Quality of Life Scale items. Descriptive statistics, Mann Whitney U, Kruskal Wallis H test and Spearman correlation analysis were used to analyze the data. A value of p < 0.05 was considered statistically significant. Results The mean age of the patients who participated in the study was 38.2 ± 10.8 years; mean BMI was 42.3 ± 6.4 before surgery and 29.0 ± 6.2 after surgery. In the study, 44.1% of the patients who underwent bariatric surgery were found to have inadequate/problematic health literacy level. Participants who had less than a bachelor’s degree (p = 0.009) and low income (p < 0.001) had significantly lower health literacy levels. In addition, a moderate positive correlation was found between overall health literacy score and quality of life score (r = 0.252; p = 0.003). Conclusions In conclusion, this study shows that improved health literacy positively affects quality of life in patients undergoing bariatric surgery and that health literacy education should be emphasized in this context. Key messages • The level of health literacy of bariatric surgery patients is a determining factor on quality of life, and therefore health literacy education is important, especially in identified risk groups. • Increased health literacy can have positive results in terms of psychosocial and physical health and improve quality of life after bariatric surgery.

‘We do not include tests and treatment for those [STI] conditions’: the trouble in navigating access and care for STIs among gay, bisexual men and transgender and other MSM in Kenya and Rwanda

Abstract Background Lesbian, gay, bisexual men, and transgender persons (LGBT) in Kenya and Rwanda have a hard time accessing healthcare, in particular sexual health screening. We used a social norms and values framework to examine determinants of access to healthcare, with specific attention to sexual healthcare. Methods We draw on cross-sectional mixed methods research in Kenya and Rwanda that examined the lived experiences of sexual and gender minorities in access to health services. A cross-sectional quantitative survey in Rwanda (n = 499) and Kenya (n = 1,550) was conducted with LGBT people. We conducted key informant interviews (n = 81), in-depth interviews (n = 48), digital storytelling (n = 3), and focus group discussions (n = 30). We used a mixed-methods thematic and content analysis to integrate quantitative and qualitative findings. Findings Accessibility and quality of care were the main barriers to healthcare services. The results indicate widespread discrimination and stigma toward LGBT people in service provision. Approximately half of the survey participants, 47%, reported challenges accessing health services, and 25% indicated they experienced discrimination in healthcare. Qualitative results link low quality of care to stigma and discrimination. “Mostly at the hospitals, there are times people take too much time discussing who we are instead of giving us the treatment we seek, and send us to mental health to first deal with our sexuality issues since they think it is a ‘sickness.’” (Focus group, Muhanga, Rwanda). Our study highlights challenges in navigating sexual healthcare in government, faith-based, and donor-funded health facilities. Conclusions Access to healthcare services, particularly sexual health screening and prevention, is a growing issue for LGBT people in Kenya and Rwanda. Stigma acts as a significant barrier to high-quality healthcare. Sensitivity training and educational opportunities for healthcare professionals are urgently needed to address stigma.

Documenting the availability and accessibility of reproductive health services for youth in Albania

Abstract Youth in Albania are initiating sexual activity at an earlier age. However, use of all forms of contraception has declined in the last decade and uptake now stands at 4%. The self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms has risen dramatically, as has reliance on abortion as a predominant method of family planning. In 2020-2022, we conducted a multi-method qualitative study in Albania to document the availability and accessibility of sexual and reproductive health (SRH) services and examine challenges that youth face when seeking SRH care. This study comprised a document review, a curriculum review, a community-based survey with 273 youth, semi-structured interviews with 15 youth, semi-structured interviews with 15 key informants, and a service mapping exercise in Tirana. Lack of adequate infrastructure and bureaucratic hurdles make it difficult for youth to navigate and access SRH services in Albania. A third of survey participants (n = 90, 33%) expressed discomfort inquiring about SRH matters, while nearly two-thirds rarely or never sought SRH services from a doctor or clinic. Furthermore, Albania’s school-based sexuality education curriculum lacks in topics, content, and responsiveness, resulting in inconsistent learning experiences and limited knowledge of SRH. Sexuality education is primarily focused on the anatomy and physiology of reproduction, leading to significant knowledge gaps in other aspects of SRH. Only half of survey participants (n = 150, 55%) had received any education on birth control, contraception, or family planning; and only few had knowledge about gender identity (n = 103, 38%), or consent (n = 77; 28%). Widespread lack of awareness and fear of judgment contribute to the underutilization of SRH services among youth in Albania. Improving knowledge and awareness, alongside investing in infrastructure and capacities, are essential to enhancing accessibility and quality of SRH services for Albanian youth. Key messages • Lack of knowledge and awareness prevent youth from accessing SRH services. • Establishing youth-friendly services and training health providers and educators are crucial to delivering confidential and non-judgmental youth-friendly SRH care.