Programming Effort Research Articles

A Review of Sanitation Options and Programming in Ghana, West Africa

This review examines Ghana’s progress in sanitation. These efforts include the containment, transport, treatment, and disposal or reuse of human waste. This research specifically examined the current sanitation processes and programming efforts within Ghana, West Africa. Some reports indicate that Ghana is the second dirtiest country in Africa and the seventh dirtiest country in the world. A review of the current water, sanitation, and hygiene (WASH) options within the country indicates that significant efforts need to be undertaken. There are multiple toilet options and current practices within the country for the disposal of excrement. Unfortunately, the municipal sewer systems and wastewater treatment facilities within the country are either broken down or severely inadequate compared to their surrounding population. Current WASH programming, extension efforts, and key factors affecting the uptake of sanitation investment are reviewed. The price point where consumers would utilize sanitation products and services was analyzed, as well as the cost-to-benefit ratio of specific technologies for community members. This review demonstrated that initiatives should be undertaken to provide more sanitation professionals, renovate and expand urban municipal sewerage systems, and provide basic access to rural community areas. It was recommended that future programming, extension, and policy efforts be intentional and include relevant stakeholders and community members to provide a greater opportunity for establishing successful and substantial efforts.

'It Made Me Change the Way I Do Business': Outcomes from Age-Friendly Community Initiatives as Systems Change.

Since the early 2000s, a global age-friendly communities (AFC) movement has called for improving the built, social, and service environments of localities for aging. Yet research on the outcomes of AFC initiatives, as programmatic efforts toward AFC progress, remains in its nascence. Drawing on "The Water of Systems Change" framework, our study aimed to address this gap by exploring the extent to which accomplishments of AFC initiatives are indicative of altering six conditions for systems change: policies, organizational practices, resource allocations, power dynamics, relationships, and mental models. We analyzed qualitative data from 26 key informant interviews across eight mature AFC initiatives in the northeastern United States. We engaged in iterative phases of thematic analysis to explore how the initiatives' accomplishments, as described by the participants, align with each of six focal conditions for systems change. We found especially robust and consistent evidence for outcomes in terms of enhanced organizational practices on aging; resource flows; connections within and across communities; and mental models about older adults. Evidence for outcomes concerning changes in power dynamics and policy was more limited. Conceptualizing AFC initiatives as systems-change interventions can bolster research, evaluation, and program development as the movement proliferates and diversifies into the 21st century. Insights can help to advance praxis that empowers AFC leaders as changemakers for "successful aging" at the level of society.

Developing and validating a self-assessment tool for assessing confidence of nurse-midwives against competency domains of the International Confederation of Midwives, in India.

While midwives are recognized as primary care-providers for maternal and new-born care in many parts of the world, India is transitioning to professional midwifery. The pathway to midwifery in India has been through integrated nursing and midwifery education. Since 2018, India has introduced an 18-month post nursing midwifery education programme. To establish a baseline for midwives' competence and measure progress, there is a need for a quick, easy-to-administer and low-cost tool that can be used at scale to guide programme efforts. This paper describes the process of validation and testing of a tool to assess the confidence of practicing nurse-midwives as a proxy indicator for competence against the seven competency domains of the International Confederation of Midwives (2013). A total of 2198 nurse-midwives, providing maternal and new-born services at the time of the study, from 442 public and private hospitals across six states in India, responded to a self-administered questionnaire. The tool is psychometrically sound and can potentially be used in low-middle-income countries to measure confidence of midwives and nurse-midwives against international competence standards. It is suitable for quick large-scale programmatic assessments within a short time period, providing evidence to inform midwifery strengthening initiatives. The tool can be contextualized to suit specific country contexts. Since it was tested in India, where a distinct cadre of midwives is not yet established and nurse-midwives provide maternity care, the tool can be easily adapted for use in other countries in the South East Asia Region with similar contexts.

Positioning LIS Students for Career Success

There is an assumption that students enter graduate programs with a certain level of knowledge and awareness about the field they have chosen to study and their career plans post-graduation. However, the literature shows that even graduate students benefit from services and programming related to career exploration and preparation. This is especially true in the library and information science (LIS) field, which offers myriad career paths and settings for graduates. Despite resources such as the ALISE Statistical Report, San José State University iSchool’s Career Trends report, and research on the core knowledge and skills desired of information professionals, extant literature examining career services provided to and desired by LIS graduate students is lacking. This project examined career planning services and programming in LIS graduate programs using a descriptive research approach. Data was collected via surveys of current LIS program administrators and enrolled graduate students. As LIS job seekers report such long and frustrating job search experiences that they consider leaving the field entirely, insights from this research will inform the creation or improvement of career services for LIS students, advance discussion of career services for graduate students, and identify exemplars that can be used to guide programming efforts. This paper will share preliminary findings from surveys completed by 25 program administrators and 400 current students.

A national survey of diversity, equity, and inclusion efforts in general surgery residency programs

A national survey of diversity, equity, and inclusion efforts in general surgery residency programs

Youth Mental Health in the Wake of the COVID-19 Pandemic.

In this article we examine the current state of youth mental health across the United States and in Delaware, and discuss the impact of the COVID-19 pandemic on the mental health and well-being of children and adolescents. We review available literature detailing the short- and long-term effects of the COVID-19 pandemic on youth mental health and discuss the resultant programmatic and legislative efforts in Delaware and nationally. The COVID-19 pandemic had a severe impact on the mental health of young people. The prevalence of depression and anxiety among children and adolescents, which was already increasing pre-pandemic, spiked after the pandemic's onset. Even as public health precautions have lifted, young people continue to struggle with mental health in conjunction with lower levels of educational achievement, hindered social development, increased screen time, diminished access to effective mental healthcare, and economic instability. The negative impact of the pandemic will continue to have ramifications on the health and wellbeing of young people for years to come. Compiling evidence examining mental health trends is an important first step to understanding the impact of the pandemic on child and adolescent mental health and developing effective solutions. Although the official state of emergency is over, the effects of the COVID-19 pandemic are far-reaching and long-lasting. It is imperative that legislators and program administrators in Delaware and nationally work to ensure that young people and their families have access to affordable, high quality mental healthcare.

Classification of Crack Coordinates through Wavelet - Analysis and CNN: Analysis of Data Preparation and Network Structure

For the two-dimensional localization of acoustic emission events (AE), artificial intelligence (AI) was applied. AE events were generated by breaking pencil leads on a granite plate measuring with dimensions of 50 cm × 50 cm × 6 cm. A total of 128 measurements were carried out at each of the 81 positions on the top surface of the granite plate. The recorded signals with 16 channels were processed using continuous wavelet transformation (CWT). The resulting RGB images served as input data for a convolutional neural network (CNN). The transformed images of the measured AE signals were converted into a four-dimensional input by considering them as deeper input, allowing for improved data capture. The result was analysed using a binary classifier according to the one-versus-all method. However, due to limited computational capacity, processing the four-dimensional data posed a challenge, resulting in significant programming effort. The results of this investigation provide insights into the potential of using AI for the localization of AE events.

Social work education and burnout prevention: a systematic review of published research

ABSTRACT Social workers face unique occupational stressors that contribute to disproportionately high rates of burnout. This situation worsened over the course of the COVID-19 pandemic, causing social work educators and professional organizations to emphasize the importance of self-care for social workers. What this means for social work education is the focus of this study. Our purpose was to understand the scope and effectiveness of burnout prevention efforts in social work undergraduate and graduate programs. A systematic search of the literature yielded 25 articles that met inclusion criteria. Each article was evaluated and information was extracted using a structured abstracting form. Results indicate that educational practices for burnout prevention are being delivered as independent workshops, integrated into existing social work courses, and offered as electives. Content includes mindfulness training, burnout and self-care awareness, and resilience skills development. Outcomes include increased burnout recognition, self-care implementation, skills development, and improved mental health. Disproportionately high burnout rates for social workers could potentially be addressed through implementing a comprehensive approach to teaching burnout prevention throughout the established social work training curriculum and teaching resilience skills at the micro, mezzo, and macro levels of practice.

Justice, Equity, Diversity, and Inclusion (JEDI) in Introductory Technical and Professional Communication (TPC) Courses Across Institutions

ABSTRACT The social justice turn of the last two decades has spurred significant scholarship, but much remains to be done to gauge the impact of social justice scholarship on programmatic and curricular efforts. Programmatic and curricular development provides the primary, most important platform and “nurturing ground for promoting and enacting social justice” (p. 39), and that should engage our attention. This article is one such attempt, even if small, at contributing to this work by investigating justice, equity, diversity, and inclusion (JEDI) initiatives in introductory TPC classes across institutions in TPC programs nationwide. It reports the results of a survey of instructors of introductory TPC courses across US institutions as well as an analysis of syllabi used by those instructors. Noting a multiplicity of macro- and micro-level challenges to JEDI work, the authors call for increased and targeted curricular discussion of JEDI as well as focused support and training for instructors at the institutional and programmatic levels.

Alignment of parent-proxy report and teen self-report of adverse childhood experiences among U.S. teens

PurposeData on adverse childhood experiences (ACEs) among teens is collected using a single informant, a parent-proxy, or teen self-report. Little is known about alignment between these approaches. MethodsSurveys were administered online to teens ages 15–17 and their parents (n = 522 dyads) using the AmeriSpeak panel. We present descriptive statistics on the prevalence and measures agreement for 18 ACEs based on teen self-report and parent-proxy report. We fit multivariable models examining associations between teen and household demographic characteristics and discordance in ACE report. ResultsBased on teen-self report and parent-proxy report, cumulative and individual ACE prevalence was overall similar. However, discordance was found in individual ACE reports within teen-parent dyads (discordance ranged: 2.9–21.2 %). Lowest agreement was among ACEs related to abuse, neglect, and violence victimization and highest among household challenges. Furthermore, parent-teen dyads with LGB+ youth (vs. heterosexual) and Black, Hispanic, and multiracial or another race (vs. White) youth were more likely to have discordant responses among several ACEs. ConclusionsSurveillance and programmatic efforts should consider the type of ACE and the reporter when using data to inform prevention strategies. Teen self-report for abuse, neglect, and violence victimization and community challenges ACEs are particularly important to capture.

Process Evaluation of a Pilot Food Insecurity Resource Navigation Program Integrated Within Pediatric Primary Care: Utilizing RE-AIM to Inform Program Scale-up

Objective: The purpose of this study was to examine the implementation and effectiveness of a novel pediatric food navigation program through a structured, comprehensive evaluation using the RE-AIM framework. Design and Participants: Data were collected from October 2021 through August 2022 for 166 pediatric patients and their families who were screened as food insecure or high-risk for food insecurity and were referred to this pilot food resource navigation program (FRNP). A total of 88 patients’ guardians consented to participate in this FRNP, receiving initial service connection. Participants were contacted via telephone by trained navigators within this health system to assess food security status across three time points (baseline, follow-up 1 [1- <3 months], and follow-up 2 [3-6 months]) and facilitate connection to appropriate community-based resources related to food assistance. Results: In this sample, we had an overrepresentation of Hispanic patients and an underrepresentation of Non-Hispanic Black and White patients relative to the available clinic population. Patients participating in the navigation program showed incremental shifts toward food security from baseline to two follow-up points. Integration within primary care was supported by physician champions across participating clinics and alignment with systemwide, updated universal screening guidelines to support projected increases in families requiring connecting to assistance programs. Through this evaluation, a comprehensive list of community-based food resource programs related to food assistance was integrated into electronic documentation for navigators to alleviate navigator burden and sustain the effect of this FRNP’s implementation. Conclusions: These findings may be used to inform expansion of current programming efforts within this FRNP and to clarify process evaluations of broader health system-based programming. Further research, building on the findings of this pilot study, is needed to examine the longitudinal, causal effect of FRNPs in pediatric food security and long-term health outcomes for replication across health systems nationwide.

Assessment of the level of patient satisfaction in Homoeopathy using 12 Item Japanese Short-form Satisfaction Questionnaire: A cross-sectional study

To strengthen the health care services, it is important to know the patients’ satisfaction about the quality of health care they are getting exposed to, in different modes of treatment. There are a few studies on the topic but are mostly related to modern medicine. It is desirable to make such efforts in other systems of medicine in view of recent emphasis of the Govt of India for the use of AYUSH. The present paper aims to present findings of a pilot study examining the usefulness of 12-item Japanese short-term self-administered questionnaire and the level of patient satisfaction following homoeopathic healthcare encounters. The pilot study was conducted in the OPD (out-patient department) of Bakson Homoeopathic Medical College & Hospital, Greater Noida (BHMC&H) to understand and estimate patients’ satisfaction related to health care service. The study was cross-sectional of 81 newly enrolled patients in the Hospital’s OPDs by using a bilingual 12-Item Japanese short form self-administered consultation questionnaire. The questionnaire appeared to be reliable and valid. The internal consistency scores of Cronbach’s Alpha range between 0.62 – 0.93. Most of the patients have given positive feedback against all the dimensions/ subscales related to patient’s care. It is recommended to conduct further longitudinal surveys with greater sample size in an AYUSH health care set up as being emphasized by the present national programme effort.

ADAPTATION OF NAVAL PENTATHLON ATHLETES TO PHYSICAL TRAINING

Rationally planned training leads to adaptation and progress, and irrational planning leads to disruption of the course of adaptation reactions and overwork. For a rational periodization it is very important to identify training concepts based on detailed analysis of fatigue development mechanisms. Proper planning and execution of training will result in an increase in effort capacity. Adaptation, viewed from a biological point of view, is a complex defense mechanism against the demands caused by environmental changes. This requires an adequate response of the organism to environmental conditions in order to survive under the new conditions. For sports training, adaptation refers to the set of transformations that the athlete's body undergoes in training, in order to develop a superior state of bio-psycho-motor balance, materialized in the easy execution of a task. Research objectives: Initial evaluation of subjects; Development of the training program; Evaluation of the level of adaptation to physical effort obtained from specific naval pentathlon training; Development of a training planning model, allowing the improvement of physical effort capacity by means specific to the naval pentathlon. Methods: The research carried out started from the premise that the appropriate use of training means specific to the naval pentathlon can lead to an improvement of the effort capacity of military students, which fully satisfies their performance needs in fulfilling combat missions arising from the graduate's model. At a preliminary stage of the research, by applying general physical training tests, we obtained an initial assessment of the research subjects. These data were a benchmark in developing the training program and setting effort parameters. The training plan thus designed contains training sessions specific to naval pentathlon trials, adapted to the normal conditions of the naval academy training process. Results: The comparative analysis of the results, based on mathematical-statistical and graphical methods, reveals significant increases in performance recorded in the final testing stage. The dynamics of the results demonstrates a significant evolution of the results of the experimental group carried out during the training program, carried out according to the designed model. This confirms to us the effectiveness of applying the training program. The statistical results confirm a very good evolution of the results for the general motor tests and for the Ruffier test. Conclusions: Regular exercise is a particularly important stimulus for adaptation. Sports training, by its specific means, aims to increase the level of performance. In order to achieve this objective, it is necessary to apply a well-defined programme in great detail. Effective training requires constant variability in programming. In addition, in order to maximize the positive transfer of training, the means used in the training lesson should be as close as possible to the characteristics of the effort. Because of this, there is a permanent conflict in training programming, between diversity and specificity. This conflict can only be successfully managed through professional intervention on the part of the coach and involvement of the athlete according to training requirements.

Sexual minority men’s experiences of, and strategies for emotional intimacy in intimate partner relationships

Emotional intimacy is key to intimate partner relationship quality and satisfaction. For sexual minority men, queer and feminist theorists consistently link emotional intimacy to diverse sexual practices and partnership dynamics formulated within the relationship. This Photovoice study adds to those insights by drawing on individual photovoice interviews with 16 sexual minority men to describe participant’s experiences of, and strategies for emotional intimacy in their intimate relationships. Analysis revealed three distinct yet entwined themes: (i) embracing vulnerabilities to drive self-acceptance; (ii) building relationality with partners; and (iii) securing connections with family, friends and community. By embracing vulnerabilities to drive self-acceptance, participants spoke to embodied courage and autonomy as key components for addressing wide-ranging emotional intimacy challenges in their relationships. In theme two, building relationality with partners, participants described how empathy, trust and reciprocity underpinned collaborative work to foster emotional intimacy. Lastly, in securing connections with family, friends and community, acceptance and inclusion were key to participants’ sense of belonging and legitimacy which aided their emotional intimacy with partners. The findings provide guidance for tailored programmatic efforts to assist sexual minority men build intimate relationships.

Community engagement in mobile and hard-to-reach populations: a community-based intervention for malaria elimination in a tri-national region of the Guiana Shield.

Several countries of the Guiana Shield are aiming at the control and elimination of malaria in areas where Artisanal and Small-scale Gold Mining (ASGM) activities predominate, raising questions about how to strengthen community engagement to improve the effectiveness of health programs. The Curema project focuses its intervention on the mobile and hard-to-reach ASGM population, complementing the efforts of national programs in the Guiana Shield. The Curema intervention combines targeted drug administration for suspected Plasmodium vivax asymptomatic carriers, the Malakit distribution, and health education activities. The primary goals of this manuscript are to outline a pathway to foster community participation in the Curema project aimed at eliminating malaria. Thus, it presents a vision of the challenges that the AGSM community poses in terms of community participation for an asymptomatic problem; and highlights the community-based model and the Information, Education and Communication (IEC) components as foundations for participation. In addition, it also presents culturally sensitive IEC strategies designed through iterative and collaborative consultative processes and other bottom-up outreach activities. The community engagement approach facilitates adaptability and responsiveness in a complex, evolving context increasing the effectiveness of interventions.

Social, economic and food insecurity among people living with HIV in Kenya during coinciding public health and environmental emergencies: a mixed-methods study

IntroductionDuring the COVID-19 response, Kenya experienced widespread regional floods, resulting in the displacement of communities and agricultural loss. This study aimed to characterise food insecurity and other social and economic...

Considerations to Optimize Structurally Responsive Work Environments for U.S. Military Specialty Physicians.

Recruitment, training, and retention of wartime critical specialty physicians may be stymied by discrimination and abuse. It is unclear to what extent the US combat specialty physicians witness or experience discrimination and abuse, whether they or others intervene, and if they would subsequently discourage people from entering their field. The present study surveyed US active duty anesthesiologists, emergency medicine physicians, and orthopedic surgeons (N = 243; 21% response rate). A generalized linear model evaluated the extent to which gender, specialty, service, and number of witnessed/experienced negative/stigmatizing comment/event types were associated with burnout. A bootstrapped mediation analysis evaluated whether gender and burnout were mediated by the number of comment/event types. The sample was majority non-Latine White (87%) and men (66%) with tri-service and specialty representation. The most commonly reported negative/stigmatizing comment/event types were related to pregnancy (62%) and parental leave (61%), followed by gender and assigned sex (42%), lactation (37%), and sexual harassment (35%). Of the respondents who witnessed/experienced such comments/events, self-intervention was reported after comments regarding lactation (43%), assigned sex and gender (42%), race and ethnicity (41%), pregnancy (41%), parental leave (37%), and sexual harassment (24%). Witnessing another person intervene was reported after sexual harassment (25%) and comments/events regarding race and ethnicity (24%), pregnancy (20%), assigned sex and gender (19%), lactation (19%), and parental leave (18%). Nonintervention was reported after comments/events related to parental leave (42%), pregnancy (38%), sexual harassment (26%), lactation (26%), assigned sex and gender (26%), and race and ethnicity (22%). Respondents reported moderate-to-high intervening likelihood, importance, and confidence. Respondents reporting neutral to extremely agree on prompts indicating that pregnant active duty physicians are trying to avoid deployment (P = .002) and expect special treatment that burdens the department (P = .007) were disproportionately men (36% and 38%, respectively) compared to women (14% and 18%, respectively). The highest proportion of neutral to extremely agree responses regarding discouraging specialty selection were reported in relation to transgender and gender diverse students (21%), followed by cisgender female students (18%); gay, lesbian, or bisexual+ students (17%); cisgender male students (13%); and racial and ethnic minoritized students (12%). In the primary model, the number of witnessed/experienced comment/event types was associated with greater burnout (0.13, 95% CI 0.06-0.20, P = .001), but women did not report significantly different levels of burnout than men (0.20, 95% CI -0.10 to 0.51, P = 0.20). The number of comment/event types mediated the relationship between gender and burnout (0.18, 95% CI 0.06, 0.34; P < .001). Although reported intervening confidence, likelihood, and importance were high, it is unclear whether perceptions correspond to awareness of intervention need and behaviors. Bivariate differences in burnout levels between men and women were fully explained by the number of comment types in the mediation model. Annual trainings may not effectively address workplace climate optimization; institutions should consider targeted policy and programmatic efforts to ensure effective, structurally responsive approaches.

Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030's Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data.

The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals' self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access. We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users. We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric. Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers-individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex. Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward.

Awareness of skin cancer screening coverage in U.S. healthcare plans: Is there a need to better educate the public?

ObjectivesTo understand whether financial barriers or the lack of accessibility to dermatology services was a significant motivation for the public to seek free skin cancer screening. MethodsAn anonymous and voluntary survey was administered to participants of The Sun Bus free skin cancer screening program in 2023 at U.S. outdoor events in Colorado, Texas, Arizona, New Mexico, Iowa, Wyoming, Missouri, and Montana. 491 respondents answered questions on motivation, healthcare coverage, and demographics. Survey data was analyzed using Qualtrics’ crosstab IQ and statistical tests software. ResultsSkin screening found suspicious lesions in 45 % of 1300 participants with 18 % of respondents sharing a previous history of skin cancer. Concern for a lesion or Curiosity were the two top reasons for 60 % of respondents to seek free skin screening and remained the top reasons after data was stratified by gender, age, or income. Only 15 % of respondent were motivated by the cost of dermatology services or a long wait to see a dermatologist. A total of 38 % of people surveyed reported comprehensive plans covering skin screening while 46 % were unaware of the inclusion of screening in their healthcare plan. Notably, this unawareness increased up to 52 % among younger and less affluent respondents. Additionally, females were less likely than males to be aware of skin screening options in their healthcare plans. ConclusionsThis work highlights the significance of promoting public awareness of dermatology services covered by health insurance and the need for continued efforts in skin cancer education and screening programs.

Socio-ecological influences on access to abortion care in Costa Rica: a qualitative analysis of key perspectives from clinical and policy stakeholders

Costa Rica prohibits abortion except under narrow circumstances to save the pregnant person’s life. The country boasts historically strong support for social policy and human rights, while also presenting a complex and restrictive abortion access landscape. From September 2021 to March 2022, we conducted 23 interviews with obstetrician-gynecologist (OB/GYN) physicians, OB/GYN medical residents, and policy stakeholders to explore the socio-ecological influences on abortion access in Costa Rica. We sampled clinicians and policy stakeholders from the Universidad de Ciencias Médicas listserv through snowball sampling and conducted semi-structured in-depth interviews in Spanish. We identified limited access to comprehensive sexual health education, lack of support from interpersonal networks, inadequate provider knowledge and training, financial and migratory status, and both provider and community stigma as substantial barriers to abortion access. This study addresses a gap in published research around the social determinants of abortion in Costa Rica and sheds light on the attitudes and opinions of the medical and policy stakeholder communities about abortion access. The results highlight the need for expanded access to comprehensive sexual health education, abortion-related training for healthcare providers, and increased programming efforts, such as funding, outreach, and implementation, to ensure comprehensive reproductive health services are available and accessible, especially for vulnerable populations in Costa Rica.