Primary Health Care Clinics Research Articles

Prevalence of depressive symptoms in adolescents living with HIV in Johannesburg, South Africa

Background: Adolescents living with HIV (ALWHIV) are more vulnerable to developing depressive symptoms. Despite this knowledge, the screening for depression is not routinely integrated into HIV treatment programmes.Aim: The study aimed to determine the prevalence of depressive symptoms among ALWHIV.Setting: The study was carried out in the primary healthcare clinics and an antiretroviral clinic situated in a district hospital, West Rand District, Johannesburg.Methods: This was a cross-sectional study of 125 ALWHIV. The modified Patient Health Questionnaire for Adolescents (PHQ-A) was used to screen for depressive symptoms with a score of ≥ 5 deemed significant. A distress protocol was used for immediate psychological intervention.Results: The prevalence of depressive symptoms was 44.8% and the majority of ALWHIV reported mild-moderate symptoms (36.8%). Overall, 25.6% of adolescents had suicidal behaviours. Those with psychosocial difficulties and those who reported a previous suicide attempt were 3.6 (adjusted odds ratio [aOR] 3.59, 95% confidence interval [CI]:1.17–11.03) and 6.9 (aOR 6.93, 95% CI:1.39–34.55) times likely to develop depressive symptoms, respectively.Conclusion: A high prevalence of depressive symptoms was found in ALWHIV. Psychosocial difficulties and previous suicide attempts were predictive factors for depressive symptoms. This highlights the unmet need for the integration of mental health screening and overall mental health services into adolescent HIV programmes.Contribution: This study emphasises an urgent need for routine mental health screening and prompt psychosocial support in ALWHIV.

REASSURED evaluation of the Bioline HCV point-of-care testing for diagnosing hepatitis C virus infection in primary healthcare settings of Ghana: a study protocol

IntroductionHepatitis C virus (HCV) infection is a silent epidemic that needs a comprehensive and contextualised approach to manage. Access to readily available, affordable and acceptable HCV point-of-care (POC) in vitro...

Community-based infant hearing screening: Outcomes of a rural pilot programme.

Community-based universal newborn hearing screening (UNHS) has not been fully realised in South Africa despite the availability of contextually relevant early hearing detection and intervention guidelines. Research has confirmed the feasibility of implementing UNHS programmes in urban contexts; however, limited information exists for rural contexts. The aim of the study was to describe the outcomes in terms of coverage rate, referral rate and follow-up rate of a 1-year UNHS pilot programme implemented at three primary health care (PHC) clinics in the Limpopo province. A descriptive retrospective review of 2 302 audiological records of infants who underwent NHS between July 2014 to June 2015 was conducted. The mean age at first-stage screen was 112 days (16 weeks). The coverage rate was 87% for the infants screened at 3- and 10- days clinic visits and 27% for infants screened at the 6-week immunisation visit. The first-stage referral rate was 33.9% and 8.3% for the overall second stage referral for diagnostic audiology services. The follow-up rate for rescreens at the clinical level was 77%, while for initial diagnostic assessments, it was 26%. Although not all benchmarks were met within the first year of implementation, the high coverage- and low referral rates, especially in the last 6 months, are the first steps in improving the outcomes of the screening programme.Contribution:The findings confirm the feasibility of implementing community-based UNHS programmes in rural areas in South Africa. Regular monitoring and evaluation contribute to the success of screening programmes.

Women's Responsiveness and Utilization of Family Planning and Childhood Immunization Services at Primary Health Care Clinics

Women's Responsiveness and Utilization of Family Planning and Childhood Immunization Services at Primary Health Care Clinics

Leveraging Digital Health Data to Transform the United Nations Systems for Palestine Refugees for the Post Pandemic Time

ABSTRACT The COVID-19 pandemic presented a grave threat to the continuity of health services that UNRWA provides to 5.9 million Palestine Refugees in the Near East. UNRWA runs 140 primary health care clinics, providing approximately nine million medical consultations a year. During the pandemic, UNRWA’s e-Health system (and other digital health tools) were crucial in maintaining health services. The e-Health system enabled the identification of at-risk patients and transformed UNRWA’s services for sustainability and efficiency. Innovations like telemedicine and two smartphone applications (e-NCD and e-MCH) enhanced service delivery and staff management. To evaluate the effectiveness of digital health integration in UNRWA’s services during and after the pandemic, the team analyzed reports, events, and e-Health data from 2019–2022. Results show that digital tools, like e-NCD and e-MCH applications, helped reduce COVID-19 among Palestine Refugees, enabling remote care and continuous access to essential health services. Digital health has now become essential in UNRWA’s post-pandemic operations. This paper offers a paradigm for future outbreak responses. By harnessing the power of digital health, UNRWA’s e-Health system served as a beacon of hope, demonstrating how innovative approaches can empower patients, enhance health care outcomes, and ensure equitable access to health care services during crisis situations and beyond.

Real-world analysis of safety, tolerability, and adherence to nirmatrelvir-ritonavir (paxlovid) in primary care COVID-19 outpatients.

This retrospective cross-sectional study aims to evaluate the safety, tolerability, and adherence of patients prescribed Nirmatrelvir-ritonavir (Paxlovid) in outpatient settings, focusing on its use in managing category 2 COVID-19 patients across three primary healthcare clinics in Selangor, Malaysia. Data were collected from the Paxlovid pharmacy registry and medical records at Klinik Kesihatan Seksyen 7, Klinik Kesihatan Seksyen 19, and Klinik Kesihatan Kelana Jaya between April 1, 2022, and November 30, 2022. This study analysed data from 415 category 2 COVID-19 patients aged ≥ 18years. The primary and secondary outcomes included the assessment of patient demographics, Paxlovid dosing, current medication, changes in drug regimen, adherence, and adverse drug reactions (ADR). Pharmacists follow-ups were conducted on days 3 and 5 post-medication initiation. The majority (79.5%) of the cohort experienced ADR, predominantly dysgeusia, diarrhoea, body ache, vomiting, and nausea. Despite this, the ADRs were generally well-tolerated, with no severe impacts reported. High adherence was observed, with 96.9% of patients completing the 5-day regimen. The primary reasons for non-adherence included adverse effect intolerability, dosing ambiguity, forgetfulness, concerns about ADR, and perceived health improvement. Notable medications interacting with Paxlovid were simvastatin, amlodipine, and atorvastatin, and 21.7% of 23 concurrent medications were found not to comply with the recommended interventions by the University of Liverpool COVID-19 Drug Interaction database. Paxlovid demonstrates a high level of safety and tolerability in outpatient COVID-19 patients, with optimal adherence observed. This study underscores the vital role of healthcare professionals in managing Paxlovid within primary healthcare and highlights the need for broader research and direct patient involvement to enhance treatment strategies against COVID-19.

Profiling patterns of patient experiences of access and continuity at team-based primary healthcare clinics (Canada): a latent class analysis

BackgroundAccess to primary healthcare services is a core lever for reducing health inequalities. Population groups living with certain individual social characteristics are disproportionately more likely to experience barriers accessing care. This study identified profiles of access and continuity experiences of patients registered with a family physician working in team-based primary healthcare clinics and explored the associations of these profiles with individual and organizational characteristics.MethodsA cross-sectional e-survey was conducted between September 2022 and April 2023. All registered adult patients with an email address at 104 team-based primary healthcare clinics in Quebec were invited to participate. Latent class analysis was used to identify patient profiles based on nine components of access to care and continuity experiences. Multinomial logistic regression models were fit to analyze each profile’s association with ten characteristics related to individual sociodemographics, perceived heath status, chronic conditions and two related to clinic area and size.ResultsBased on 87,155 patients who reported on their experience, four profiles were identified. “Easy access and continuity” (42% of respondents) was characterized by ease in almost all access and continuity components. Three profiles were characterized by diverging access and/or continuity difficulties. “Challenging booking” (32%) was characterized by patients having to try several times to obtain an appointment at their clinic. “Challenging continuity” (9%) was characterized by patients having to repeat information that should have been in their file. “Access and continuity barriers” (16%) was characterized by difficulties with all access and continuity components. Female gender and poor perceived health significantly increased the risk of belonging to the three profiles associated with difficulties by 1.5. Being a recently arrived immigrant (p = 0.036), having less than a high school education (p = 0.002) and being registered at a large clinic (p < 0.001) were associated with experiencing booking difficulties. Having at least one chronic condition (p = 0.004) or poor perceived mental health (p = 0.048) were associated with experiencing continuity difficulties.ConclusionsThese results highlight individual social and health characteristics associated with increased risk of experiencing healthcare access difficulties, such as immigration status and education level and/or continuity difficulties when having a chronic condition and poor perceived mental health. Facilitating appointment booking for recently arrived immigrants and patients with low education, integrating interprofessional collaboration practices for patients with chronic conditions and improving care coordination and communication for patients with mental health needs are recommended.

Ideal Clinic Realisation and Maintenance programme implementation in rural KwaZulu-Natal.

The delivery of quality primary healthcare (PHC) services is vital for enhancing the health status of rural communities, yet persistent barriers exist in resource-constrained rural settings. The study explored perspectives on the barriers to and facilitators of implementing the Ideal Clinic Realisation and Maintenance (ICRM) programme as a quality assurance initiative in a rural KwaZulu-Natal subdistrict. Professional nurses and healthcare managers from seven PHC clinics in a rural subdistrict of KwaZulu-Natal and supervising managers from a district hospital participated in this study. Telephonic semi-structured interviews were conducted using a qualitative case study approach with the purposively selected sample. Data were inductively and thematically analysed. Themes included ICRM programme organisation, barriers and facilitators for implementing the ICRM programme. Barriers in rural PHC settings included overburdened clinics, suboptimal infrastructure, staff burnout, poor communication and non-adherence to clinical guidelines. Despite obstacles, programme implementation was facilitated through stakeholder support and teamwork. Participants emphasised the need for infrastructure upgrades, more human and physical resources, and maintenance of stakeholder support. If challenges are mitigated and supportive factors are leveraged, the potential for successful programme implementation and improved healthcare delivery can benefit both healthcare providers and recipients.Contribution:Through providing insight into the perspectives of both implementers and supervisors, the study informs stakeholders and policymakers about difficulties encountered and potential improvements to be made in the implementation of the ICRM programme in rural PHC.

Assessing the use of unstructured electronic health record data to identify exposure to firearm violence.

Research on firearm violence is largely limited to people who experienced acute bodily trauma and death which is readily gathered from Inpatient and Emergency Department settings and mortality data. Exposures to firearm violence, such as witnessing firearm violence or losing a loved one to firearm violence, are not routinely collected in health care. As a result, the true public health burden of firearm violence is underestimated. Clinical notes from electronic health records (EHRs) are a promising source of data that may expand our understanding of the impact of firearm violence on health. Pilot work was conducted on a sample of clinical notes to assess how firearm terms present in unstructured clinical notes as part of a larger initiative to develop a natural language processing (NLP) model to identify firearm exposure and injury in ambulatory care data. We used EHR data from 2012 to 2022 from a large multistate network of primary care and behavioral health clinics. A text string search of broad, gun-only, and shooting terms was applied to 9,598 patients with either/both an ICD-10 or an OCHIN-developed structured data field indicating exposure to firearm violence. A sample of clinical notes from 90 patients was reviewed to ascertain the meaning of terms. Among the 90 clinical patient notes, 13 (14%) notes reflect documentation of exposure to firearm violence or injury from firearms. Results from this study identified refinements that should be considered for NLP text classification. Unstructured clinical notes from primary and behavioral health clinics have potential to expand understanding of firearm violence.

A Qualitative Examination of Clinician Anxiety about Suicide Prevention and Its Impact on Clinical Practice.

Clinician distress about working with patients at risk for suicide is well documented in the literature, yet little work has examined its pervasiveness across clinical settings. We conducted a secondary analysis of qualitative data gathered from 26 clinicians in primary care and outpatient mental health clinics serving both adult and child clients on their perception of evidence-based practice use for suicide screening, assessment, and brief intervention. Qualitative data were coded for any mentions of clinician anxiety or emotional response, and brief quantitative measures were collected to characterize our sample. When discussing broader barriers to implementation, 85% of participants spontaneously mentioned anxiety or heightened emotional responses related to delivering suicide prevention practices to those at risk for suicide. Common themes included low self-efficacy in suicide prevention skills, distress related to escalating care, efforts to alleviate such distress, and difficulty related to tolerating the uncertainty inherent in suicide prevention work. Similarly, while standardized anxiety ratings for participants were consistent with those of non-clinical norming samples, clinicians reported mild to moderate anxiety when screening for suicide risk (M = 3.64, SD = 2.19, Range = 0-8) and engaging in safety planning (M = 4.1, SD = 2.88, Range = 1-7) on post-interview surveys. In contrast, survey responses reflected generally high self-efficacy in their ability to screen for suicide risk (M = 7.66, SD = 1.29, Range = 5.25-10) and engage in safety planning (M = 8.25, SD = 0.87, Range = 7-9.5). Findings highlight pervasiveness of clinician distress when implementing suicide prevention practices and can inform future suicide prevention implementation efforts.

Newly qualified primary care nurses' preparedness to make sound clinical judgements in practice.

The public health sector in South Africa provides care to more than 40 million people, with primary health care (PHC) clinics acting as most patients' first contact with healthcare services; 80% of patients are treated by primary care nurses. Primary care nurses' poor clinical judgment can result in poor patient care, complications and death. However, newly qualified primary care (NQPC) nurses' preparedness for making sound clinical judgements in practice has not been evaluated in Gauteng province, South Africa. To determine NQPC nurses' level of preparedness in making sound clinical judgements in practice. A quantitative, non-experimental, descriptive design was used. The target population was NQPC nurses. A census method was used to select all NQPC nurses in public PHC facilities in three health districts of Gauteng. The sample size comprised 77 NQPC nurses, and data were collected using a self-administered questionnaire. The findings indicated that 83% of NQPC nurses were able to notice salient changes in patients' conditions, 43% were able to correctly interpret the changes that were noticed, but only 42% prioritised the correct patient care. The results reflect that 50.2% of the NQPC nurses in public PHC facilities in the three districts in Gauteng were functioning at exemplary levels.Contribution:This article highlighted NQPC nurses' level of preparedness to make sound clinical judgements within a year after qualifying.

Effectiveness of a task-sharing collaborative care model for the detection and management of depression among adults receiving antiretroviral therapy in primary care facilities in South Africa: A pragmatic cluster randomised controlled trial

BackgroundHIV is characterised by high rates of comorbidity with mental health conditions including depression, as such, the detection and treatment of comorbid depression is critical to achieve viral load suppression. This study evaluated the effectiveness of a collaborative care intervention for depression among adults with comorbid depression symptoms receiving ART in primary health care (PHC) facilities. MethodsWe conducted a pragmatic cluster-randomised trial in 40 clinics in the North West province of South Africa. PHC clinics were stratified by sub-district and randomised in a 1:1 ratio. Participants were ≥ 18 years, receiving ART, and had depression symptoms indicated by Patient Health Questionnaire-9 (PHQ-9) score ≥ 9. Intervention clinics received: i) supplementary mental health training and clinical communication skills for PHC nurses; ii) workshops for PHC doctors on treating depression; and iii) lay counselling services. Using mixed effects regression models, we assessed co-primary outcomes of PHQ-9 response at 6 months (≥50 % reduction in baseline PHQ-9 score) and viral load suppression at 12 months (viral load<1000 copies/mL). ResultsThe intervention had no effect in PHQ-9 response (49 % vs 57 %, risk difference (RD) = −0.08, 95 % CI = -0.19; 0.03, p = 0.184) or viral load suppression (85 % vs 84 %, RD = 0.02, 95 % CI = −0.01; 0.04, p = 0.125). Nurses referred 4298 clinic patients to counsellors, however, only 66/1008 (7 %) of intervention arm participants were referred to counsellors at any point during the study. LimitationsThe highly pragmatic approach of this trial limited exposure to the counselling component of the intervention and referral to doctors for initiation of antidepressant treatment was extremely low. ConclusionThe trial showed no effect of a district-based intervention to strengthen collaborative care for depression. The trial revealed the extent of the treatment gap in the context of scaling up mental health services. Trial registrationClinicalTrials.gov (NCT02407691); Pan African Clinical Trials Registry (201504001078347).

The Experiences of Pregnancy Among Adolescent Girls in Jordan

ObjectiveTo explore the experience of pregnancy among adolescent girls ages 16 to 19 years in Jordan. DesignDescriptive exploratory qualitative design. SettingParticipants were recruited from antenatal clinics and postpartum wards in Ministry of Health primary health care clinics and hospitals across Jordan. This included a wide geographic area in Jordan that covered several cities: Amman, Zarqa, Irbid, As-Salt, and others. ParticipantsThe total number of participants was 13. Most participants were primiparous, and three were multiparous. Five participants were recruited during the postpartum period, seven in the second and third trimester, and one during the first trimester. MeasurementsData were collected using semistructured and audio-recorded interviews and analyzed concurrently. Thematic analysis was used. A total of 13 interviews were conducted. ResultsTwo core themes emerged from the study: Navigating the Change and Reflecting on the Experience of Pregnancy. The first theme included four subthemes: Making Adjustments, Seeking Support, Searching for Information, and Feeling the Responsibility. ConclusionConsidering the impact of pregnancy on adolescent girls and their fetuses, early marriages should be reconsidered in legal and health policies in Jordan and worldwide. Adolescents expressed a need for more information about pregnancy. Age-appropriate comprehensive sexual education that includes discussion of gender issues and women’s empowerment is needed. Online sources of pregnancy information targeting the needs of adolescents are also recommended. More research is needed to explore the needs of pregnant adolescents in different social and cultural contexts.

Mapping local evidence on early recognition and management of people with potential cancer symptoms: a narrative review

Aim Early cancer detection has potential to improve outcomes. However, many patients in South Africa present when the disease is at an advanced stage. The World Health Organization recommends two approaches to early cancer detection: screening asymptomatic individuals, and early recognition and management of symptomatic individuals. This paper focuses on the latter. For people with potential cancer symptoms, the journey to diagnosis is complex and influenced by multiple factors. Most symptomatic people will self-present to primary health care clinics, where primary health care providers are pivotal in triage. Methods This article presents local insights into cancer awareness measurement tools: community-level cancer symptom awareness, lay beliefs, and symptom appraisal; factors influencing the journey from symptom discovery to diagnosis; primary health care provider challenges in assessing symptomatic individuals, and interventions to support symptom assessment and help-seeking. It draws on findings from the African Women Awareness of CANcer (AWACAN) project and a narrative review of relevant published articles on journeys to cancer diagnosis in SA (2013-2023). Findings Very few cancer awareness measurement tools have been locally validated, hampering comparison and limiting opportunities for intervention development and evaluation. The AWACAN study developed and validated a local cancer awareness measurement tool for breast and cervical cancer. Studies show that most people in SA need information on cancer risk, symptoms, and pathways to care. Barriers to accessing health care include financial, infrastructural, safety, stigma, and previous health facility experiences. Primary health care providers require support for symptom assessment and referral systems. There is limited local work on developing and evaluating interventions to improve timely cancer diagnosis. Conclusions This paper underscores the importance of prioritising early recognition and management of people with symptomatic cancer as part of a comprehensive cancer control plan, providing insights for improving the journey to diagnosis.

Self-care practices among professional nurses employed in primary health care clinics

Background: Professional nurses typically promote and advocate self-care practices to their patients to achieve better health outcomes, but rarely engage in these practices themselves.Methods: A qualitative, descriptive phenomenological approach was used in this study. Ten professional nurses employed in different primary health care facilities were purposively sampled. Semi-structured interviews were conducted to collect data, which were analysed using Colaizzi’s data analysis strategy, and data saturation was reached.Results: Two themes were identified. Theme 1: the participants expressed that internal and external factors compromised self-care practices, such as subconscious self-neglect, insufficient resources, and a depressed economy, which encouraged them to work extended hours. Theme 2: participants’ holistic well-being was compromised, as they neglected their mental well-being.Conclusion: Self-care practices among professional nurses seem unachievable. The extent of this population’s self-care neglect was evident during the coronavirus disease 2019 (COVID-19) pandemic when professional nurses globally gave of themselves relentlessly.Contribution: This is the first study conducted on the topic in the City of Ekurhuleni, and the findings will provide relevant stakeholders with a directive on what strategies, policies, and guidelines to develop and implement to make self-care practices attainable for professional nurses.

Body image of postmenopausal women

Abstract: Body image is a multidimensional, subjective, and dynamically changing concept that includes personal perceptions and feelings towards one's body. Menopause is associated with significant changes in external appearance and physical functioning. Aim: The study aimed to determine how women of postmenopausal age assess their bodies and what factors influence this evaluation. Material and methods: The research was conducted in six randomly selected gynaecological and primary health care clinics in Lublin. A total of 510 women were included in the study. A diagnostic survey was used as the research method. The research tool was a questionnaire consisting of a self-constructed part (socio-demographic data) and a standardized Body Esteem Scale questionnaire (BES). Results: In all subscales (sexual attractiveness, body control, and physical fitness), average results were obtained, although the highest was about body weight control (M = 5.85±2.00) and the lowest was related to sexual attractiveness (M = 4.78±2.17). The values of all subscales were significantly differentiated by the subjective assessment of the participant's health status (p&lt;0.05). The values of sexual attractiveness were significantly related to the place of residence (p = 0.021) and the employment status of the participants (p = 0.030). The values of self-assessment of physical fitness were significant with the place of residence (p = 0.012) and the marital status of the participants (p&lt;0.001). Conclusion: Women in postmenopausal age perceive their bodies in all categories (sexual attractiveness, body weight control/body strength, physical fitness) at an average level, indicating the need for psychosocial support. Providing them with support with their self-acceptance, and perhaps lifestyle changes, may improve their self-esteem to their body image.

Prevalence and Risk Factors of Postpartum Depression in Palestinian Women in the Hebron Governorate, Palestine

Background Despite the increased interest from researchers in Postpartum depression (PPD) globally, related studies are limited in Palestine and do not provide a comprehensive understanding of PPD. Objective We examined the factors that determine post-partum depression among Palestinian mothers in Hebron governorate. Methods A cross-sectional study was conducted in 122 governmental primary healthcare clinics in Hebron Governorate. A convenient sampling method was used to collect data from 435 using a self-administered questionnaire using the Edinburg Postnatal Depression Scale. Results The mean EPDS scale score was 10.56 (SD 5.273), and 36.1% had a score of ≥13, indicating moderate-to-severe depression symptoms. The study results revealed that psychosocial factors were significantly associated with PPDS and play a crucial role in the development of PPD, such as the history of depression, being exposed to domestic violence before and during pregnancy, poor husband support, unplanned pregnancy, fear of infant’s gender, and in addition to anemia than other factors. Conclusion A high prevalence of PPD was found among Palestinian women in this study. The study proposes screening women for trauma or domestic violence and assessing their social support, inquiring about pregnancy intention, and discussing family planning. Delivering iron supplements to pregnant or postpartum anemic women is important. Women who have a history of depression, domestic abuse, or lack social support should receive psychological and medical treatment. Mental health services must be included in the after-birth care protocol to train primary health clinic staff to recognize and treat PPD.

The impact of the nurse practice environment, workload, and professional support on job outcomes and standards of care at primary health care clinics in South Africa: A structural equation model approach

BackgroundThere is substantial evidence on the associations between a positive nurse practice environment and improved nurse and patient outcomes, as well as the factors that mediate these associations, in high-income countries and in hospital settings. The knowledge gaps in African and primary health care settings motivated this empirical study. ObjectiveThe objective of this study was to examine the impact of the dimensions of the nurse practice environment, specifically human resource management, foundations for nursing care, and participation in clinic affairs, on job outcomes and standards of care. DesignA cross-sectional study was conducted between November 2021 and June 2022. Setting180 primary health care clinics in two South African provinces of Gauteng and North West. Participants665 nurses of all categories. MethodsA causal model was developed with pathways between the nurse practice environment dimensions and the outcomes of job satisfaction, intention to leave, and standards of care. A set of standardised instruments was used to measure the study variables. Using structural equation modelling, workload and professional support were tested as potential mediators between the nurse practice environment and the outcome variables. ResultsThe nurses scored the domain of foundations for nursing care 71.2 out of 100 on average, indicating high agreement, while the mean scores for nurses’ participation in clinic affairs and human resources management were lower at 68.0 and 61.7 respectively. Although nurses expressed moderate satisfaction with professional support (67.7), they were less satisfied with their workload (52.2). The mean score of overall job satisfaction was moderate (58.9), with 53.8 % of the nurses reporting that they intended leaving the clinic where they were working. Thirty-six percent intended leaving the nursing profession, indicating low intention to stay. The final mediation model was judged to fit the data adequately based on goodness-of-fit indices, confirming that workload and professional support had a mediating role between the nurse practice environment dimensions of interest and both nurses’ job outcomes and standards of care. ConclusionsWe have highlighted the value of supportive practice environments, effective workload management, and enhanced professional support in improving nurses’ job outcomes and satisfaction with standards of care. Improving nurses’ practice environments at primary health care level may have a wide-ranging impact on the performance of the health system. Therefore, primary health care facility managers should ensure that workload is distributed equitably, professional support for nurses is enhanced, and the overall work environment is improved.

Effectiveness of a nurse-led family empowerment program to improve the quality of life among pregnant adolescents: A randomized controlled trial.

The present study examined the effects of a nurse-led family empowerment program on the quality of life of Palestinian pregnant adolescents. This was a randomized controlled trial with a two-group pre-/post-test design. The sample consisted of 58 pregnant adolescents recruited from six governmental primary health care clinics in Palestine. Participants were randomly allocated in equal numbers to either the control group (n = 29), which received routine care, or the experimental group (n = 29), which received both routine care and the study program. Data collection instruments included a demographic form and the WHO Quality of Life-BREF (WHOQoL-BREF). Data were collected twice: at 32 or 33 weeks' gestation to establish a baseline and at 36 or 37 weeks' gestation post-test. Statistical analyses were performed and included descriptive statistics, chi-square and t-tests. The study findings indicated a significant increase in the mean quality of life scores of the experimental group in the post-testcompared to the pre-test (P < 0.001). Additionally, pregnant adolescents in the experimental group demonstrated significantly higher post-test QoL scores than those in the control group (P < 0.001). The nurse-led family empowerment program emerges as a viable and efficacious alternative intervention for improving the quality of life among Palestinian pregnant adolescents. The study was registered with the NIH U.S. National Library of Medicine ClinicalTrials.gov on 01/09/2021 with the registration code NCT05031130. It can be accessed via this link: https://classic. gov/ct2/show/NCT05031130.

Accessibility of TB diagnostic services at primary healthcare clinics in the eThekwini district, South Africa: a geospatial analysis

BackgroundImproving geographic access can aid in managing tuberculosis (TB) by enabling early diagnosis and treatment initiation. Although geospatial techniques have been used to map the transmission patterns of drug-resistant TB...