Past Negative Experiences Research Articles

Reducing Consumer–Brand Incongruity Through Corporate Social Responsibility and Brand Trust: Exploring Negative Word‐of‐Mouth (NWOM)

ABSTRACTDrawing upon consumer–brand disidentification theory and balance theory, this study examines symbolic and ideological incongruity in consumer–brand relationships through an original conceptual model shaped by negative past experiences, brand trust, perceived corporate social responsibility (CSR), and negative word‐of‐mouth (NWOM). A preliminary study was conducted to explore the dimensions of consumers' negative past experiences by topic detection. Latent Dirichlet allocation (LDA) topic modeling was undertaken to analyze online consumer reviews (n = 6095) about a coffee chain brand. The dimensions detected in this preliminary study were included in the research model and further analyzed in the main study. The main study, a cross‐sectional consumer survey (n = 522), tested the original research model by way of partial least squares structural equation modeling (PLS‐SEM) on SmartPLS. The findings showed that negative past experiences consisted of product‐related, service‐related, and technology‐related problems and negatively influenced brand trust. It was found that brand trust and perceived CSR negatively affected symbolic and ideological incongruity, while symbolic and ideological incongruity positively influenced NWOM. The findings provide empirical evidence for balance theory by showing that the three critical domains of consumer–brand relationships (ideological, symbolic, and experiential) provide a complex cognitive model that covers personal‐symbolic and moral‐societal aspects of consumer–brand disidentification and consequent NWOM intentions. In line with consumer–brand disidentification theory, the results contribute to the literature by demonstrating the direct negative impacts of brand trust and perceived CSR on symbolic and ideological incongruity, as well as the direct positive impacts of symbolic and ideological incongruity on NWOM.

About the need for a Swiss digital health ‘Sistine Chapel’ – lessons from 25 years of health policy

Abstract Background The Swiss government’s ‘DigiSanté’ program 2025-2034 aims to address Switzerland’s delay in digitising its healthcare system. Public and professionals’ trust is central for the implementation of digital health initiatives and partially based on past experiences with the digital health system. To inform DigiSanté, it is crucial to analyse the evolution of the socio-political discourse surrounding health data sharing in Switzerland in the past 25 years to identify the main obstacles encountered and lessons learned during this period. Methods We designed a multi-method study comprising a policy analysis of 65 Swiss policies on health data sharing from 1998 to 2023; scoping review of 250 editorials; sentiment analysis of 400 news articles from six major Swiss newspapers; and thematic analysis of transcripts from 11 online interviews with key stakeholders. Results We identified 32 key policy milestones in Swiss health data sharing, with the COVID-19 pandemic emerging as a trigger for present policymakers’ awareness of health data’s potential and the need for healthcare system digitization. The troubled implementation of the Electronic Patient Dossier (EPD) and its negative narrative are identified as more central in eroding long-term public trust than scandals. Primary obstacles to implementation of the EPD include misaligned stakeholders’ interests, slow policy processes, lack of professional support, low public awareness, and technical interoperability issues. Future strategies involve increasing actors’ involvement to establish a common vision and strategy and improving public communication. Conclusions The present socio-political discourse on health data sharing in Switzerland is shaped by past negative experiences with the EPD, compounded by additional scandals. To cultivate public trust, stakeholders should collaborate to align interests and ensure all parties work cooperatively toward common goals. Key messages • National and international scandals marginally affect public trust compared to the impact of the negative narrative surrounding the slow EPD implementation. • Misalignment of stakeholder interests is the main barrier to implementing health data sharing initiatives, causing delays and trust erosion.

Symptom bothersomeness and life interference support Rome clinical criteria as clinically relevant indicators of DGBI.

Irritable bowel syndrome (IBS) and functional dyspepsia (FD) are common disorders of gut-brain interaction (DGBI). The Rome IV criteria are the gold standard for research when diagnosing DGBI. However, bothersomeness, or the degree to which symptoms are distressing or disruptive to a person's daily life, is a potential treatment-seeking motivator that is not assessed by the Rome criteria. The Rome Foundation developed and published diagnostic criteria for clinical practice that include bothersomeness. We aimed to evaluate these constructs via patient focus groups to determine what prompts healthcare-seeking as a means to assess its value in the Rome clinical criteria. Adults meeting Rome IV criteria for IBS, FD, or both participated in focus groups in Australia and the United States. Semi-structured interview transcripts were analyzed using Template Thematic Analysis, with three a priori and other a posteriori themes refined iteratively through team discussion and consensus. Participants confirmed the frequency and duration of symptoms was not sufficient to reflect illness experience. Four major themes emerged: (1) Bothersomeness should be included in assessments of IBS and FD; (2) Patients find many DGBI symptoms bothersome; (3) Bothersomeness traverses multiple domains of quality of life; (4) Patients may hesitate to seek medical advice due to past negative experiences. These findings support the value of the Rome Clinical Criteria. They emphasize the importance of expanding assessments of patients with DGBI to include how bothersome they perceive symptoms to be, how much symptoms interfere with their daily life, and what may moderate their decisions to seek treatment.

A Qualitative Study with Informal Caregivers and Healthcare Professionals for Individuals with Head and Neck Cancer on the Usage of AI Chatbots.

Informal caregivers (ICs), including the patient's spouse, close relatives, or friends, play an important role in caregiving individuals with head and neck cancer (HNC). AI-based chatbots might offer information and assistance related to caregiving. This study presents the viewpoints of ICs and healthcare professionals (HCPs) on using AI-based chatbots in caring for individuals with HNC. A total of six focus groups were conducted with 15 ICs and 13 HCPs from three Swedish university hospitals. The study uncovers a widespread hesitancy toward the intention to use AI-based chatbots among ICs and HCPs. Factors contributing to this reluctance include their distrust in chatbot-provided information, negative past experiences of using chatbots, and lack of human connection in chatbot interactions. Embracing a holistic approach is crucial when designing chatbots, ensuring active user engagement and incorporating their perspectives into the design process.

Understanding the failure of government debunking communication: insights from China

ABSTRACT This study uses qualitative methods to examine the challenges faced by authoritarian regimes in managing rumors during public crises, focusing on the Urumqi government’s (the capital of the Xinjiang Uyghur Autonomous Region in Northwestern China) response to COVID-19 lockdown rumors. The analysis identifies four factors contributing to the failure of government debunking communication: Rejection due to Negative Past Experiences, Discourse Reinterpretation by Mismatched Criteria, Disregard Toward Inflexible Statements, and Opposition Arising from Perceived Superficial Efforts. These factors culminate in a core mechanism termed ‘Emotional Resistance Anchored in Distrust,’ highlighting how negative past experiences shape public distrust and foster resistance to government communication. The findings challenge the assumption of automatic public trust in authoritarian contexts and underscore the importance of aligning government actions with public needs and expectations, particularly during crises.

Perioperative pathways for children with neurodevelopmental conditions and behaviours that challenge: An evaluation of parent experiences for service improvement.

To elicit experiences of parents of children with neurodevelopmental conditions using a new perioperative pathway. Parents of children accessing an adapted perioperative clinical pathway in a tertiary children's hospital between July 2019 and December 2020 were invited to participate. A mixed method study was conducted comprising a short survey questionnaire followed by telephonic interviews. From 67 postal surveys sent out, 20 were completed. Six out of 20 parents participated in phone interviews and one parent submitted written prose. Parents were positive about their experiences. Six themes emerged: Negative past experiences (highlighting the need for adapted perioperative pathways); Reasonable adjustments (improving child and parent's hospital journey); Facilitating communication, convenience and collaboration; Parent's satisfaction and relief; Barriers to overcome and Areas in need of improvement were discussed. Parents of children with neurodevelopmental conditions report great satisfaction and relief from their experiences of a more efficient, streamlined and stress-free way for their child to have tests or procedures done. Parents report improved communication, convenience and collaboration with staff resulted in timely, safe and high-quality care.

Breast Cancer Screening among African Immigrants in the United States: An Integrative Review of Barriers, Facilitators, and Interventions.

The purpose of this review was to synthesize the available literature on breast cancer-screening barriers, facilitators, and interventions among U.S. African immigrants. Following the integrative review framework and PRISMA guidelines for reporting systemic reviews, five electronic databases were searched: PubMed, CINAHL, PsycINFO, Medline, and Google Scholar. Studies were included if they were published in English language journals after 1 January 2000 and reported data on breast cancer-screening barriers, facilitators, or interventions among U.S. African immigrants. Barriers and facilitators reported by studies were descriptively examined and synthesized by two authors and classified as aligning with one of the three levels of influences based on the social-ecological model (intrapersonal, interpersonal, and community). Interventions promoting breast cancer screening were narratively summarized. Search procedures retrieved 1011 articles, with 12 meeting the criteria for inclusion in the review (6 qualitative and 6 quantitative). Intrapersonal barriers included limited awareness, fear of pain, language barriers, health concerns, transportation issues, costs, and negative past experiences. Interpersonal barriers involved modesty, spiritual beliefs, and lack of support, while community-level barriers included provider and healthcare-system challenges. Regarding facilitators, past screening experiences and health insurance were the most commonly reported intrapersonal facilitators. The only interpersonal facilitator identified was observing other women experience a breast cancer diagnosis and undergo treatment. Community-level facilitators included appointment reminders, scheduling assistance, culturally congruent interpreters, transportation to screening facilities, and patient navigators. Three articles reported outcomes of breast cancer-screening interventions. All three were pilot studies and reported increased knowledge and attitudes regarding breast cancer screening following the respective interventions. One study examined the uptake of breast cancer screening following the intervention, with results indicating an increase in screening. Findings provide a comprehensive synthesis of factors influencing breast cancer screening among African immigrants and highlight the need for future research on the topic. This review was registered with Prospero (CRD42024502826) before the initiation of search procedures.

Perceptions of safety during everyday travel shaping older adults’ mobility in Bengaluru, India

BackgroundIn the context of socially sustainable urban development, comfortable, safe, and accessible public transport is crucial to motivating people to travel more sustainably. Using the framework given by Masoumi and Fastenmeier (2016) to examine the concepts of safety and security, we explore how perceptions of safety about different transport modes shaped the mobility of older adults in Bengaluru, India.MethodsIn-depth telephonic interviews were conducted with 60 adults, aged 50 years and over, residing in urban Bengaluru, using a semi-structured in-depth interview guide to explore the perceptions of safety in different transport modes. Observations were conducted prior to the COVID-19 pandemic. Applying thematic analysis, we present how the perceptions of safety during their everyday travel shaped their mobility.ResultsAccording to our research, older adults’ perception of safety during their everyday travel is shaped by past negative experiences with accidents, pickpocketing, theft of mobile phones, and chain snatching. In addition, the Covid-19 pandemic exacerbated the already existing inequalities, further limiting older adults’ mobility to carry out regular activities such as buying groceries, socialising, making a hospital visit, or going to work due to the fear of getting infected.ConclusionOur findings indicate that the use of public transport needs to be encouraged among older adults by enhancing necessary safety features following the age-friendly cities framework. Furthermore, it can help policymakers develop transport polices, which suit the mobility needs of older adults.

A Qualitative Content Analysis of Perceived Individual and Relational Consequences of Sexual Compliance and Their Contributors

Sexual compliance (i.e., consensually engaging in sex despite a lack of desire for it) is common in committed intimate relationships, but the consequences of compliance for the well-being of the individual and the relationship are poorly understood. We investigated the perceived consequences of sexual compliance and perceptions of factors contributing to negative/positive consequences by applying qualitative content analysis to free-text retrospective survey responses from 107 (mostly) Finnish adults. We identified five themes of personal consequences (emotions and mood, sexual experience, sexual desire, pressure and violations, and physical pain), four of relational consequences (relationship satisfaction, partner’s response, relationship interaction, and value alignment), and nine of possible factors contributing to negative/positive consequences (communication, self-esteem, motives for sex, relationship factors, agency and self-knowledge, mental health and stress, psychological flexibility, societal norms, and past negative experiences). Perceived consequences varied widely across individuals, both in terms of whether any positive or negative consequences were experienced and whether compliance was perceived as improving or worsening specific domains of well-being. We discuss the themes identified in relation to previous theories of sexuality and intimate relationships and offer hypotheses that can be tested in future quantitative studies.

Examining Foreign Language Learners’ Speaking Anxiety: The Case of English L2 Learners

Examining speaking anxiety in learners of foreign languages is important not only for the learners but also for teachers and curriculum designers. The study aimed to examine foreign language learners’ speaking anxiety in 100 M.A. students at Prince Sattam bin Abdulaziz University in Saudi Arabia. The survey was directed to M.A. students. The study used the PSCAS. The findings demonstrated that a variety of factors, including a limited vocabulary, pronunciation difficulties, social pressure, a lack of confidence, and negative past experiences, might contribute to speaking anxiety. Together, these components create a complex web of worry that keeps students from being open to vocal communication. However, the study also discovered several practical strategies that M.A. candidates could employ to boost their speaking confidence and lessen their speaking anxiety. These strategies included role-playing games, conversations in small groups, the use of technology, group projects involving collaborative speaking, regular constructive criticism, availability of interactive language labs, practical language application, progressively more difficult assignments, cultural immersion programs, and workshops on public speaking. By using these strategies, students can establish a supportive learning environment that promotes language proficiency and confidence. Based on the findings of this study, several recommendations were proposed, such as integration of supportive learning environments, utilization of technology, implementation of practical language application, training in public speaking, gradual complexity in assignments, and promotion of positive thinking.

How stressful was the COVID-19 vaccination procedure? Comparison between mass vaccination centers and general practices

Negative past experiences with vaccines or unfamiliar environments can be sources of stress during the COVID-19 vaccination procedure. We examined whether the perceived stressfulness of the vaccination procedure differ between mass vaccination centers and general practitioner (GP) practices. A survey was distributed (07/2021–10/2021) among newly vaccinated individuals in ten GP practices (n = 364) and two vaccine centers (n = 474). Stress was low at all sites. The perceived stressfulness of the procedure was higher among younger participants and those in GP practices, and increased with longer waiting time at the site. Stress decreased with better comprehensibility of the procedure and higher satisfaction with patient education. Participants who expressed greater concern about the health risks of COVID-19 vaccines perceived the vaccination procedure as more stressful. Our findings indicate opportunities for improvements in future vaccination campaigns and highlight the important role of healthcare providers in mitigating stress by addressing individual concerns.

Factors Influencing Community Engagement during Guinea Worm and Polio Eradication Endgames in Chad: Recommendations for "Last Mile" Programming.

Community engagement is a strategy commonly used in health and development programming. Many disease eradication programs engage with communities through different structures and mechanisms to detect, report, contain, and respond to the diseases they target. Qualitative operational research was conducted in a district of Chad co-endemic for both dracunculiasis (i.e., Guinea worm disease) and circulating vaccine-derived poliovirus to reveal factors influencing community engagement behavior in the context of eradication-related programming. Women and men from six communities and stakeholders from the local, district, and central levels were recruited to participate in focus group discussions and semi-structured in-depth interviews. A thematic analysis was performed to identify barriers and facilitators of community engagement. Barriers to community engagement included mistrust in exogenously established health program initiatives (i.e., initiatives designed by partners external to targeted program communities) resulting from negative past experiences with external entities and community groups and the lure of profit-motivating community engagement. Subgroup and intersectionality analyses revealed that gender and other identities influence whether and to what extent certain members of the community engage in a meaningful way. Facilitators of community engagement included leadership and the influence of authorities and leaders in community participation, perceived benefits of being engaged with community-based initiatives, and use of incentives to enhance community participation. Study findings may be used to inform the refinement of community engagement approaches in Chad and learning agendas for other "last mile" disease eradication programs.

To stay or to switch: the mediation effect of scepticism on switching intention to halal cosmetics from the perspective of the pull-push-mooring theory

PurposeThe purpose of this paper is to extend the Push-Pull-Mooring (PPM) theory to identify the factors influencing Muslim customers’ switching intention to halal-certified cosmetics.Design/methodology/approachA snowballing sampling method was used to distribute an online questionnaire via social media platforms. Of 403 questionnaires, only 363 were usable. SmartPLS 4 was used to analyse the data using a structural equation modelling approach.FindingsThe findings of this paper confirmed that social influence and scepticism have a positive effect on the switching intention to halal cosmetics. However, compatibility with current cosmetic products has a negative effect on the switching intention to halal cosmetics. On the other hand, negative side effects and negative past experiences have a positive effect on scepticism. Scepticism was also found to mediate the relationship between negative side effects and negative past experiences toward the switching intention to halal cosmetics.Practical implicationsThe findings of this study primarily benefit cosmetics manufacturers, whether halal-certified or otherwise.Originality/valueThis study extends the PPM theory with negative side effects and negative past experiences. Moreover, this study also introduces new relationships and untested relationships between scepticism and switching intention. This study shows the mediating effects of scepticism on the relationship between negative side effects and negative past experiences toward switching intention.

A qualitative study on the Virtual Emergency Department care experiences of equity-deserving populations.

Patients from equity-deserving populations, such as those who are from racialized communities, the 2SLGBTQI+ community, who are refugees or immigrants, and/or who have a disability, may experience a unique set of challenges accessing virtual models of care. The objective of this qualitative study was to describe the experiences of patients from equity-deserving communities and their family members who received care from a Virtual Emergency Department (ED) in Toronto, Canada. Forty-three participants (36 patients and 7 family caregivers) with different and intersecting identities who used the Virtual ED participated in the study. Semi-structured interviews were conducted to explore reasons for accessing the Virtual ED, barriers to access, and how the Virtual ED met their care needs and expectations, including ways their experience could have been improved. Thematic analysis was used to identify themes from the data. Patients from equity-deserving populations described negative past experiences with ED in-person care, which included recounts of discrimination or culturally insensitive care while waiting to see the ED physician or nurse. Conversely, participants found the Virtual ED to be a socially and culturally safe space since they could now by-pass the waiting room experience. However, virtual care could not replace in-person care for certain issues (e.g., physical exam), and there was a need for greater promotion of the service to specific communities that might benefit from having access to the Virtual ED. Targeted outreach to help raise awareness of the service to equity-deserving communities is an important future direction.

Oral health knowledge, literacy and behavior of pregnant women: a qualitative study in a northeastern province of Thailand

BackgroundPregnancy is a unique period of women’s lives, and oral health is an important public health indicator during this period. Pregnant women have increased vulnerability to oral health problems. The study aimed to describe oral health knowledge, literacy and behavior of pregnant women in a northeastern province of Thailand.MethodsA descriptive study was used. Twenty pregnant women who attended antenatal care clinics of eight public hospitals in the province were recruited by use of purposive sampling. They participated voluntarily in individual interview. The Health Belief Model was used as conception framework. All data were transcribed and subjected to content analysis.ResultsFive categories emerged: Misbelief and lack of knowledge, Oral health problems and dental care seeking, Oral health information from different persons, Self-care management of oral health, and Fear of and anxiety towards dental treatment. The findings showed that low knowledge of need for treatment, little importance to oral health and low priority of dental needs affect the demand for dental care. Fear of and anxiety towards dental treatment were the results of negative past experiences of neglecting dental care. Some women perceived health benefits of practicing self-care of oral health during pregnancy.ConclusionThe findings help to better understand the oral health issues of pregnant women and provide baseline information for oral health promotion. Such promotion and culturally appropriate care should be integrated in maternal health education classes.

Referral pathways to early intervention services for psychosis and their influence on perceptions of care: An interpretive phenomenological analysis.

Most young adults experiencing psychosis enter early intervention services (EIS) via inpatient and emergency departments. These experiences are suggested to negatively impact their views of treatment and engagement in EIS. However, limited research has examined the impact of young adults' prior help-seeking experiences on these outcomes. The present study aimed to explore how young adults engaged in EIS have experienced initial help-seeking and make sense of these experiences in the context of their current treatment. Using an interpretative phenomenological analysis approach, semi-structured interviews were conducted with 12 young adults (mean age = 24.83) within their first 3-12 months of treatment in EIS. Interviews aimed to examine their experiences of help-seeking and referral to EIS as well as the impact of these experiences on their subsequent perception of, and engagement with EIS. 3 superordinate themes emerged: (1) Navigating the Maze of Healthcare (2) Dignity and (3) Impact of Help-Seeking and Referral Experiences. Participants with referral pathways involving urgent care services described more adversity during their referral pathway and tended to describe help-seeking experiences as contributing to negative views towards EIS and diminished engagement in treatment. The impact of early negative experiences with healthcare on views towards EIS and engagement is evident in participants' accounts. Sense making was further contextualized by participants' illness insight, degree of recovery, and social support throughout experiences. Emergent themes highlight the need for psychiatric services to emphasize service users' dignity and for EIS to provide opportunities for patients to process past negative mental healthcare experiences to strengthen engagement.

Getting to the bottom of why children with spina bifida use the emergency department: A qualitative analysis of parent and stakeholder perspectives

Children with Spina Bifida (SB) have considerable healthcare utilization, including Emergency Department use (EDU). We aimed to elicit reasons for EDU using qualitative analysis of interviews with both patient-caregiver dyads and stakeholders. A cohort of children with SB followed at our institution between 2016 and 2020 was identified and patient and clinical characteristics abstracted. Purposeful sampling by age and degree of past EDU was performed. Semi-structured interviews of dyads were performed using iteratively revised interview guides. Spanish-language interviews were conducted by a native Spanish speaker and transcripts professionally translated. Supplemental interviews with stakeholders, namely knowledgeable healthcare professionals, were also conducted. A qualitative framework approach was used for analysis, including open followed by closed independent coding with calculation of inter-rater reliability. A final interpretation of coding reports assessing convergence, divergence, and variation in themes across participant characteristics. 116 families (4 Spanish-speaking) and 7 stakeholders were interviewed. Sampling yielded a heterogenous cohort for EDU (56% with 0-10, 44% with >10 visits) and age (25% 0-4, 44% 5-11, 31%>11 years). IRR was optimal (κ=0.9). Themes in perceived reasons for EDU were 1) desire for "one-stop-shop" care, 2) an emergent medical problem, 3) providers' instructions, 4) negative past healthcare experience, 5) intrinsic caregiver moderators, and 6) temporospatial influences. Themes 1, 2, and 5 predominated in dyads, whereas themes 6, 3, and 5 were most common in stakeholders. Stakeholders focused largely on negative institutional and patient characteristics. Among dyads only, theme #1 was disproportionately emphasized by Spanish-speaking patients. Families desired access to coordinated expert care, testing and imaging. The ED offers this for children with SB, regardless of clinical acuity. This may be especially valued by families with inherent challenges to navigating the healthcare system. Negative experiences in community clinical settings, healthcare provider recommendations and intrinsic parental factors were themes that seemed to contribute to seeking this "one-stop-shop" type of care. Care coordination may reduce ED reliance, but themes for the interviews suggest a systems-based efforts should weave in the community care setting. For both stakeholders and caregivers, the ED represented a valued form of immediate access to multispecialty, expert care and testing in the context of perceived lack of timely, coordinated outpatient care. This may be moderated by intrinsic caregiver factors and negative past experiences. Although stakeholders discussed ideas that fit into patient-caregiver themes, the also uniquely focused on systems-based and patient-caregiver limitations.

Overestimating the intensity of negative feelings in autobiographical memory: evidence from the 9/11 attack and COVID-19 pandemic

ABSTRACT When recalling autobiographical events, people not only retrieve event details but also the feelings they experienced. The current study examined whether people are able to consistently recall the intensity of past feelings associated with two consequential and negatively valenced events, i.e. the 9/11 attack (N = 769) and the COVID-19 pandemic (N = 726). By comparing experienced and recalled intensities of negative feelings, we discovered that people systematically recall a higher intensity of negative feelings than initially reported – overestimating the intensity of past negative emotional experiences. The COVID-19 dataset also revealed that individuals who experienced greater improvement in emotional well-being displayed smaller biases in recalling their feelings. Across both datasets, the intensity of remembered feelings was correlated with initial feelings and current feelings, but the impact of the current feelings was stronger in the COVID-19 dataset than in the 9/11 dataset. Our results demonstrate that when recalling negative autobiographical events, people tend to overestimate the intensity of prior negative emotional experiences with their degree of bias influenced by current feelings and well-being.

‘Let him die in peace’: understanding caregiver’s refusal of medical oxygen treatment for children in Nigeria

IntroductionEfforts to improve oxygen access have focused mainly on the supply side, but it is important to understand demand barriers, such as oxygen refusal among caregivers. We therefore aimed to...

Exploring gestational age, and birth weight assessment in Thatta district, Sindh, Pakistan: Healthcare providers' knowledge, practices, perceived barriers, and the potential of a mobile app for identifying preterm and low birth weight.

Reliable methods for identifying prematurity and low birth weight (LBW) are crucial to ending preventable deaths in newborns. This study explored healthcare providers' (HCPs) knowledge, practice, perceived barriers in assessing gestational age and birth weight and their referral methods for preterm and LBW infants. The study additionally assessed the potential of using a mobile app for the identification and referral decision of preterm and LBW. This qualitative descriptive study was conducted in Thatta District, Sindh, Pakistan. Participants, including doctors, nurses, lady health visitors, and midwives, were purposefully selected from a district headquarter hospital, and private providers in the catchment area of Global Network's Maternal and Newborn Health Registry (MNHR). Interviews were conducted using an interview guide after obtaining written informed consent. Audio recordings of the interviews were transcribed and analyzed using NVIVO® software with an inductive approach. The HCPs had extensive knowledge about antenatal and postnatal methods for assessing gestational age. They expressed a preference for antenatal ultrasound due to the perceived accuracy, though accept practical barriers including workload, machine malfunctions, and cost. Postnatal assessment using the Ballard score was only undertaken sparingly due to insufficient training and subjectivity. All HCPs preferred electronic weighing scales for birth weight Barriers encountered included weighing scale calibration and battery issues. There was variation in the definition of prematurity and LBW, leading to delays in referral. Limited resources, inadequate education, and negative parent past experiences were barriers to referral. Foot length measurements were not currently being used. While mobile apps are felt to have potential, unreliable electricity supply and internet connectivity are barriers. The HCPs in this study were knowledgeable in terms of potential tools, but acknowledged the logistical and parental barriers to implementation.