Psychosocial Counseling Research Articles

Impact of psycho-social support and counselling services in mitigating the risk of radicalisation among youths

The purpose of this study is to examine the effectiveness of psycho-social support and counselling services in mitigating youth radicalisation in Mombasa County, Kenya. Violent extremism poses significant risks to youth in vulnerable regions, and while psycho-social interventions have been implemented, their impact remains uncertain. This study specifically investigates whether these services enhance mental health, promote behavioural change, and build resilience against radical ideologies. Using a mixed-methods design, data were collected from 384 youth participants through structured questionnaires and semi-structured interviews. Findings indicate that sixty-one per cent of participants are aware of the available support services, revealing a need for improved outreach. Notably, sixty-eight per cent reported improvements in mental health and coping skills, and seventy-three per cent observed positive behavioural changes, which reduced their susceptibility to radicalisation. These results highlight the potential of psycho-social support in fostering resilience among at-risk youth, though limitations in awareness and accessibility persist. To enhance these services' impact, recommendations include targeted outreach programs, stigma reduction campaigns, and expansion of services to marginalised areas.

Tracking modifications to implementation strategies: a case study from SNaP - a hybrid type III randomized controlled trial to scale up integrated systems navigation and psychosocial counseling for PWID with HIV in Vietnam

IntroductionEvaluation of implementation strategies is core to implementation trials, but implementation strategies often deviate from the original plan to adjust to the real-world conditions. The optimal approach to track modifications to implementation strategies is unclear, especially in low-resource settings. Using data from an implementation trial for people who inject drugs (PWID) with HIV in Vietnam, we describe the tracking of implementation strategy modifications and present findings of this process.MethodsSNaP (Systems Navigation and Psychosocial Counseling) is a hybrid type-III effectiveness-implementation randomized controlled trial aiming to scale up the evidence-based intervention, integrated systems navigation and psychosocial counseling, for PWID with HIV in Vietnam. Forty-two HIV testing sites were randomized 1:1 to a standard or tailored arm. While the standard arm (SA) received a uniform package of strategies, implementation strategies for the tailored arm (TA) were tailored to address specific needs of each site. The central research team also met monthly with the TA to document how their tailored strategies were implemented over time. Five components were involved in the tracking process: describing the planned strategies; tracking strategy use; monitoring barriers and solutions; describing modifications; and identifying and describing any additional strategies.ResultsOur approach allowed us to closely track the modifications to implementation strategies in the tailored arms every month. TA sites originally identified 27 implementation strategies prior to implementation. During implementation, five strategies were dropped by four sites and two new strategies were added to twelve sites. Modifications of five strategies occurred at four sites to accommodate their changing needs and resources. Difficulties related to the COVID-19 pandemic, low number of participants recruited, high workload at the clinic, lack of resources for HIV testing and high staff turnover were among barriers of implementing the strategies. A few challenges to tracking modifications were noted, including the considerable amount of time and efforts needed as well as the lack of motivation from site staff to track and keep written documentations of modifications.ConclusionsWe demonstrated the feasibility of a systematic approach to tracking implementation strategies for a large-scale implementation trial in a low-resource setting. This process could be further enhanced and replicated in similar settings to balance the rigor and feasibility of implementation strategy tracking. Our findings can serve as additional guidelines for future researchers planning to report and track modifications to implementation strategies in large, complex trials.Trial registration: clinicaltrials.gov ID: NCT03952520 (first posted 2019-05-16).

7816 Implementation And Evaluation Of Clinical Care Structures For People With Differences Of Sex Development (DSD) In Germany

Abstract Disclosure: S.O. Hiort: None. M. Schnoor: None. U. Doehnert: None. M. Juergensen: None. J. Scherf: None. A. Heidenreich: None. M. Rapp: None. A. Katalinic: None. People with Differences of Sex Development (DSD) pose a challenge for healthcare. Lifelong holistic care requires a broad range of diagnostic approaches, qualified psychosocial, peer, fertility and sexual counselling, and structured therapeutic strategies including gonadal monitoring, hormone or surgical therapy. A quest has been taken to define centers of expertise for DSD and to substantiate and evaluate quality of care. Based on the criteria defined by the European Reference Network (ERN) for Rare Endocrine Conditions, 10 health care providers in Germany qualify for specialized DSD care. Quality indicators (QI) were developed through a Donabedian model to define structure, process and outcome quality mainly based on the German national guideline ”Differences of Sex Development”. Additionally, a consensus was reached though a structured process involving participating centers as well as patient organizations. Structural QIs are collected by an annual survey from the participating centers. Patient-related process and outcome data are recorded in a central registry. Patients and legal guardians receive questionnaires to collect patient-related outcome and experience measures after visits. These are measured by CHC-SUN/ YHC-SUN for treatment satisfaction and KIDDY KINDL, KIDSSCREEN 52, or WHOQOL-BREF for quality of life. An annual evaluation of all data results in a benchmarking of the participating centers. 24 indicators for structural quality were consented, 7 for process and 8 for outcome quality. Indicators of process quality comprise e.g. diagnostic procedures, case conferences, peer counseling or patient education. For structural quality there was an increase of centers fulfilling the QIs in 14 items including e.g. team composition and qualification during the study period from 2020 until 2022. Still very few centers had fixed standard operating procedures e.g. for gonadal monitoring or long-term follow up after surgery. 601 people with DSD were included into the registry from May 2021 until June 2023. In process quality there were considerable differences between centers both in QI compliance and data quality. The proportion of individuals with a genetic diagnosis varied by center from 44% to 96%. Information from questionnaires was available from 445 participants. Satisfaction with care was high. Parents reported in 86% to be very or highly satisfied with the visit, children and adolescents in 76%, and adults in 77%. Our approach allows for detailed evaluation of structural, process, and outcome quality. Health care insurers have secured appropriate funding for continuous evaluation of DSD care and the maintenance of the registry. This will allow for sustainability of the benchmarking and improvement of health care provision for people with DSD. Presentation: 6/1/2024

Experiences of genetic counselors practicing in multiple languages: Progress and places for improvement.

As awareness of the value of genetic counseling services increases, there has been greater recognition of the need to diversify service delivery into different languages. Studies within genetic counseling and related fields have identified complications that can arise from language nonconcordance between provider and patient. A strategy to mitigate language barriers is prioritizing the development of a multilingual workforce of genetic counselors (GCs) who can communicate with patients in their preferred language. This exploratory study assessed the experiences of multilingual GCs who have practiced in a clinical role with the aim to identify relevant challenges and differences when counseling in their nondominant language. Statistical analysis was performed to identify differences in session tasks and emotions experienced when counseling in one's nondominant language versus their dominant language. Data analysis identified an increase in reported difficulty level for most clinical tasks while using a nondominant language, most notably for difficulty with psychosocial counseling, disclosing results, and administrative tasks. Participants were also surveyed on employer support and resources provided. Overall, results suggest that multilingual GCs may benefit from greater support in certain areas within clinical roles to enhance their ability to provide patient care in their nondominant language.

REPRODUCTIVE HEALTH IN TRANS AND GENDER-DIVERSE PATIENTS: Psychosocial counseling of transgender and gender-diverse individuals in fertility and reproductive medicine: a narrative review.

Transgender and gender-diverse (TGD) people have similar desires for parenting as cisgender individuals but are likely to face greater barriers in accessing fertility treatment than their cisgender peers. Mental health professionals are well-positioned to advocate for and support TGD individuals seeking fertility care through pre-fertility treatment implications counseling regarding the psychosocial aspects of fertility treatment and family building. Transgender and gender-diverse (TGD) individuals experience significantly greater all-cause mortality and mental health disparities compared to their cisgender peers. Gender-affirming hormone therapy (GAHT) is a safe and effective treatment option for gender dysphoria that dramatically improves psychosocial health outcomes but may adversely impact fertility. Medical society guidelines recommend medical fertility preservation (FP) counseling and pre-fertility treatment psychoeducational implications consultation from qualified, reproductive mental health professionals (MHPs) for TGD individuals pursuing FP or third-party reproductive treatment. However, sparse literature exists specific to the structure of mental health psychoeducational consultation for TGD individuals pursuing FP. This narrative review highlights important areas for discussion in pre-fertility treatment mental health consultations. Results indicate that implications counseling should be conducted by an MHP with specialized training in reproductive mental health with TGD populations to reduce the risk of harm and promote successful emotional navigation of fertility treatment. Such counseling should be psychoeducational and not gatekeeping in nature and may include consideration of the psychosocial (e.g. emotional, relational, ethical, spiritual, social) risks and benefits of various family-building options. During these consultations, TGD individuals can explore their hopes and fears related to fertility and future family-building plans and discuss realistic treatment expectations, individual strengths, coping and communication strategies, and identify key support network members who may aid in navigating the fertility treatment process. MHPs can provide referrals to appropriate resources if necessary to help TGD individuals navigate treatment while coping with psychological symptoms and promoting behavior change.

Prevalence and factors associated with depression and anxiety among patients recovered from COVID-19: a cross-sectional study in a tertiary care hospital in Nepal

IntroductionCOVID-19 has immensely affected the mental health of all people with prominent effects among the COVID-19 survivors who underwent hospitalisation. The evidence of the long-term mental health implications among the...

Feasibility and effectiveness of cardiac telerehabilitation for older adults with coronary heart disease patients: a pilot randomized controlled trial

Abstract Background Cardiac rehabilitation is a standard and multidisciplinary treatment of exercise promotion, patient education, risk factor management, and psychosocial counseling for people with coronary heart disease (CHD) that is underutilized due to disparities in access, referral, and participation. Empirical studies suggest that cardiac telerehabilitation (CTR) have safety and efficacy comparable to traditional in-person CR, however, older adults are under-reported with effectiveness, feasibility, and usability of CTR for this population remains unclear . Purpose This study investigates the effects, usability, and feasibility of 12-week CTR on health outcomes of older people with CHD. Design A pilot randomized controlled trial with qualitative process evaluation. Methods The study randomized 43 older adults with CHD to the 12-week CTR intervention or usual care. Guided by Social Cognitive Theory, intervention group participants received individualized in-person assessment and orientation session, followed by CTR usage at home. Participants were encouraged to visit the CR website for self-learning and data uploading, use the pedometer for daily step tracking, and chat with peers and CR nurse via social media for problem-solving and mutual support. Data were collected at baseline (T0), six-week (T1), and 12-week (T2). Results Participants in the CTR intervention group showed significant improvement in daily steps (T1: β=4126.58, p=0.001; T2: β=5285, p=0.01) and health-promoting lifestyle profile (T1: β= 23.26, p<.001; T2: β=12.18, p=0.008) across study endpoints. No significant difference was observed regarding self-efficacy, quality of life, psychological symptoms, and body weight and blood pressure. Twenty participants completed the intervention, with 100% used social media for tele-consultation, 90% used the pedometer for tele-monitoring, 40% (n=8) used the website. Improving awareness on rehabilitation and a clear action focus were considered as key enablers while physical discomforts and difficulties in using the technology were described as main barriers. Conclusions The CTR is effective in improving physical activity and healthy behaviors for older adults. Considering the variation in individual cardiovascular risk factors, full-scale RCT with larger sample is needed to determine the effect of CTR on psychological symptoms, body weight and blood pressure, and quality of life. Strategies to improve user intervention usage is needed.

Cardiac Rehabilitation in Geriatric Individuals

Background: The aim of the study is a current review in the field of cardiac rehabilitation in geriatric individuals. Methods: Literature searches were conducted using PubMed, Embase and Scopus. Additional articles were identifed by searching reference lists. Results: Aging is a physiological condition in the normal process of life and leads to changes in all organs and systems. The aging process significantly affects the cardiovascular, pulmonary, musculoskeletal, and metabolic systems. Cardiac rehabilitation provides numerous psychological and physiological benefits to older adults. All comorbidities, frailty status, and social and financial factors should be comprehensively evaluated while planning cardiac rehabilitation programs that consist of the main components of exercise training, risk factor management, and psychosocial counseling in older adults. Conclusions: Regular participation in cardiac rehabilitation programs can reduce morbidity and mortality rates and improve cardiorespiratory fitness and overall health outcomes by modifying coronary artery disease risk factors in older adults with chronic conditions, including cardiovascular disease, stroke, and respiratory disease

Pelayanan Sosial Sebagai Upaya Pemenuhan Keberfungsian Sosial Disabilitas Netra di UPTD Rumoh Seujahtera Beujroh Meukarya (RSBM) Ladong Aceh Besar

Unlike normal people in general, people with visual impairment experience limitations in carrying out daily activities. In Indonesia, the number of disabilities in 2022 reached 1.5% or around 4 million people. One way to fulfill the social functioning of blind disabilities is to increase motivation and develop potential through rehabilitation at UPTD Rumoh Seujahtera Beujroh Meukarya (RSBM). This study aims to determine what forms of social services for visual disabilities at UPTD RSBM. The type of research used is a qualitative approach with descriptive methods through observation, documentation, and interviews with 5 informants. The results of this study obtained data that the form of social services is in the form of residential rehabilitation social services (Boarding) with several activities such as: Care and nurturing, mental and spiritual guidance, physical guidance, social guidance and psycho social counseling, skills guidance and accessibility services such as massage massage skills, braille reading and writing skills, rattan weaving skills, art skills, jaws computer technology skills, social assistance and resocialization guidance.

Misoprostol-induced seizures following self-abortion: a rare, but repeated occurrence

Misoprostol is a synthetic prostaglandin E1 (PGE) analogue used for medical termination of pregnancy, managing miscarriage, inducing labour, cervical ripening, and treating postpartum haemorrhage. Generally, it is safe and well-tolerated, with dose-dependent adverse effects such as nausea, vomiting, diarrhoea, abdominal pain, fever, and headache that usually resolve within a few days. However, seizures are a rare complication, occurring primarily in patients with a history of epilepsy or a predisposition to seizures and is associated with high doses and rapid administration. This case report highlights the repercussions of a misoprostol overdose used for pregnancy termination, leading to seizures induced by hyperthermia. The first patient required temporary invasive ventilation and resuscitation but recovered, whereas the second patient receiving a lower dose, exhibited milder symptoms. Both patients received psychosocial counselling prior to discharge.

Cancer predisposing syndromes in childhood and adolescence pose several challenges necessitating interdisciplinary care in dedicated programs.

Genetic disposition is a major etiologic factor in childhood cancer. More than 100 cancer predisposing syndromes (CPS) are known. Surveillance protocols seek to mitigate morbidity and mortality. To implement recommendations in patient care and to ascertain that the constant gain of knowledge forces its way into practice specific pediatric CPS programs were established. We retrospectively analyzed data on children, adolescents, and young adults referred to our pediatric CPS program between October 1, 2021, and March 31, 2023. Follow-up ended on December 31, 2023. We identified 67 patients (30 male, 36 female, 1 non-binary, median age 9.5 years). Thirty-five patients were referred for CPS surveillance, 32 for features suspicious of a CPS including café-au-lait macules (n = 10), overgrowth (n = 9), other specific symptoms (n = 4), cancer suspicious of a CPS (n = 6), and rare neoplasms (n = 3). CPS was confirmed by clinical criteria in 6 patients and genetic testing in 7 (of 13). In addition, 6 clinically unaffected at-risk relatives were identified carrying a cancer predisposing pathogenic variant. A total of 48 patients were eventually diagnosed with CPS, surveillance recommendations were on record for 45. Of those, 8 patients did not keep their appointments for various reasons. Surveillance revealed neoplasms (n = 2) and metachronous tumors (n = 4) by clinical (n = 2), radiological examination (n = 2), and endoscopy (n = 2). Psychosocial counselling was utilized by 16 (of 45; 35.6%) families. The diverse pediatric CPSs pose several challenges necessitating interdisciplinary care in specified CPS programs. To ultimately improve outcome including psychosocial well-being joint clinical and research efforts are necessary.

IJCM_331A: Helping beyond the Helpline – Experience from a Unique Model for Mental Health Care among Frontline workers during COVID – 19 Pandemic in Andhra Pradesh

Background: Psychological issues among Health Care Workers (HCWs) in COVID-19 stem from the fact that normal people are being exposed to extraordinary situations. Facing this critical situation, it is essential to ensure that these personnel are identified early and offered appropriate intervention. Hence, AIIMS Mangalagiri partnering with UNICEF started a project to reach out to all frontline workers in the state of Andhra Pradesh. Objectives: To set up a Psycho-Social Counselling (PSC) system for healthcare & other front-line workers in the state of Andhra Pradesh to handle stress due to COVID–19 To conduct capacity-building programs for health care & other front-line workers to prevent psycho-social conditions arising due to COVID–19 Methodology: A simple Mental Health Screening Questionnaire (MHSQ) was developed and validated in the local language. After getting prior approvals, a Google form link of the MHSQ was sent via email, SMS, and WhatsApp to every frontline worker in the state. Consenting participants with scores above 6 were contacted personally by the psychologists for further detailed evaluation. A helpline number for counseling was publicized and psychologists conducted sessions on mental health awareness and coping strategies in various institutes across the state. Results: About 8,217 respondents attempted the MHSQ out of which detailed mental health evaluation (GAD-7, PHQ-9, CAGE, AUDIT, and PSQI) was done for 392 respondents. The most common issues identified were Anxiety (45%), Insomnia (42%), Depression (12%), and Substance Abuse (2%). Also, as a part of the mental health capacity-building campaign around 4,500 healthcare workers like nurses, Anganwadi teachers, and ANMs were trained offline across the state, along with the District Mental Health team. Conclusion: Mental health can have a significant impact on the competence of frontline workers. In addition to existing interventions available, confidential mental health intervention and service provision are the need of the hour.

What influence mothers’ mental health and health care seeking behaviors for their malnourished children in Nepal: building evidence for a broader perspective

IntroductionImplementing research projects on community-based health care interventions in low-ressource settings is feasible with specific methods and applications. In order to critically understand all ins and outs of influencing factors involved in health care pathways for children and their mothers, we must consider to implement more than one research in the same context.ObjectivesThe objective of this presentation is to showcase the continuum of research projects starting from the assessment of the effectiveness of a combined nutrition and psychosocial intervention and its economic evaluation, and how that led to exploring social representations of malnutrition in order to better understand the link with health care seeking behaviours.MethodsThe FUSAM cluster randomized control trial included 427 were severe acutely malnourished (SAM) children and their mothers. They were divided in two groups receiving the standard nutrition treatment while the intervention group benefited from five psychosocial sessions. A battery of tests for child development and maternal mental health was administered pre and post intervention. For the economic evaluation, a data collection was conducted with 98 community members and District Public Health Office personnel in Saptari and 17 Action contre la Faim and government personnel in Kathmandu. Finally, a mixed-method study comparing social representations of malnutrition included 376 adults in Saptari and Nuwakot district. Data analysis was performed according to the study design: a multivariate model analysis for the CRCT, a micro-costing methodology to cost data collection and analysis was favored. For the mixed-method analysis, descriptive and inductive analysis were performed.ResultsRegarding the child development, children in the intervention group showed higher scores than children in the control group at all time points. And the economic evaluation showed that the costs of adding psychosocial counselling to an existing CMAM program was approximately EUR 28,788 for 6 centers per year. However, referrals of children through the community-based screening were not optimal. The findings related to health seeking behaviors showed that different meaning categories were simultaneously resorted to by community members leading to different representations of SAM children and that relevant health advises were neither systematically nor uniquely associated to medical categories but are linked to different meaning categories depending on the cultural context.ConclusionsMultiplying research projects is crucial to mitigate the limitations of the studies often facing numerous contextual challenges and ultimately to leverage further opportunities.Disclosure of InterestNone Declared

Safety and compliance of long-term low-dose ondansetron in alcohol use disorder treatment.

BackgroundThe increasing prevalence of alcohol use disorder (AUD) and the parallel surge in alcohol-associated liver disease (ALD) emphasize the urgent need for comprehensive alcohol management strategies. Low-dose ondansetron (AD04, a 5-HT3 antagonist) was shown recently to be a promising treatment for AUD with a specific genotypic profile (5-marker). The liver safety of AD04 has never been evaluated in subjects with AUD. The aim of the present study was to assess the liver safety profile of AD04 compared with placebo in subjects with AUD. MethodsLiver biochemical parameters were assessed in subjects with AUD with a 5-marker genetic profile who participated in a Phase 3 randomized controlled trial and received either twice-daily, low-dose AD04 (ondansetron 0.33 mg twice daily) or matching placebo, combined with brief psychosocial counseling. ALT, AST, GGT, Serum Bilirubin, MCV, and Prothrombin were evaluated at weeks 0, 12, and 24. Adverse cardiac events, general well-being, and study completion were also assessed. ResultsLow-dose AD04 did not significantly change biochemical markers of liver injury, such as ALT, AST, and Serum Bilirubin. While patients with AUD displayed elevated GGT levels, typically associated with increased alcohol consumption, this parameter remained unaffected by low-dose AD04. Notably, no significant adverse effects were observed due to oral low-dose AD04 treatment. ConclusionsLow-dose AD04 has the potential to be a safe treatment option for subjects with AUD and ALD, indicating the need for an RCT for this specific cohort. Such a trial would pave the way for the design of a precision treatment for combined AUD with ALD.

Unveiling the relationship between psychological adaptation and problem-solving skills in gifted intermediate school students: A Saudi Arabian perspective

This study examines the relationship between psychological adaptation and the problem-solving skills of gifted students at the intermediate school stage in Saudi Arabia to determine the difference in the level of influence according to gender and grade. The study involved a random sample of 187 gifted students, whose responses were received through an online questionnaire. This quantitative study used a T-test, one-way analysis of variance, two-way analysis of variance and regression analysis. The findings indicated a positive effect of psychological adaptation on all dimensions of problem-solving skills. In addition, substantial differences were observed between males and females in the four dimensions of psychological adaptation. The results also showed no differences between males and females regarding the problem-solving skill dimensions of problem definition and decision making. However, there were significant differences between the remaining dimensions and the total general dimension of problem-solving skills. The study recommends that psychological aspects be included as the core and cognitive objectives when planning care programmes for the gifted, intensifying the role of psychosocial counselling and rehabilitation programmes for teachers and educational mentors.

Two implementation strategies to support the integration of depression screening and treatment into hypertension and diabetes care in Malawi (SHARP): parallel, cluster-randomised, controlled, implementation trial

Although evidence-based treatments for depression in low-resource settings are established, implementation strategies to scale up these treatments remain poorly defined. We aimed to compare two implementation strategies in achieving high-quality integration of depression care into chronic medical care and improving mental health outcomes in patients with hypertension and diabetes. We conducted a parallel, cluster-randomised, controlled, implementation trial in ten health facilities across Malawi. Facilities were randomised (1:1) by covariate-constrained randomisation to either an internal champion alone (ie, basic strategy group) or an internal champion plus external supervision with audit and feedback (ie, enhanced strategy group). Champions integrated a three-element, evidence-based intervention into clinical care: universal depression screening; peer-delivered psychosocial counselling; and algorithm-guided, non-specialist antidepressant management. External supervision involved structured facility visits by Ministry officials and clinical experts to assess quality of care and provide supportive feedback approximately every 4 months. Eligible participants were adults (aged 18-65 years) seeking hypertension and diabetes care with signs of depression (Patient Health Questionnaire-9 score ≥5). Primary implementation outcomes were depression screening fidelity, treatment initiation fidelity, and follow-up treatment fidelity over the first 3 months of treatment, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, NCT03711786, and is complete. Five (50%) facilities were randomised to the basic strategy and five (50%) to the enhanced strategy. Between Oct 1, 2019, and Nov 30, 2021, in the basic group, 587 patients were assessed for eligibility, of whom 301 were enrolled; in the enhanced group, 539 patients were assessed, of whom 288 were enrolled. All clinics integrated the evidence-based intervention and were included in the analyses. Of 60 774 screening-eligible visits, screening fidelity was moderate (58% in the enhanced group vs 53% in the basic group; probability difference 5% [95% CI -38% to 47%]; p=0·84) and treatment initiation fidelity was high (99% vs 98%; 0% [-3% to 3%]; p=0·89) in both groups. However, treatment follow-up fidelity was substantially higher in the enhanced group than in the basic group (82% vs 20%; 62% [36% to 89%]; p=0·0020). Depression remission was higher in the enhanced group than in the basic group (55% vs 36%; 19% [3% to 34%]; p=0·045). Serious adverse events were nine deaths (five in the basic group and four in the enhanced group) and 26 hospitalisations (20 in the basic group and six in the enhanced group); none were treatment-related. The enhanced implementation strategy led to an increase in fidelity in providers' follow-up treatment actions and in rates of depression remission, consistent with the literature that follow-up decisions are crucial to improving depression outcomes in integrated care models. These findings suggest that external supervision combined with an internal champion could offer an important advance in integrating depression treatment into general medical care in low-resource settings. The National Institute of Mental Health.

Perceptions and preferences for genetic testing for sickle cell disease or trait: a qualitative study in Cameroon, Ghana and Tanzania

Sickle cell disease (SCD) is a single gene blood disorder characterised by frequent episodes of pain, chronic anaemic, acute chest syndrome, severe disease complications and lifelong debilitating multi-system organ damage. Genetic testing and screening programs for SCD and the sickle cell trait (SCT) are valuable for early diagnosis and management of children living with SCD, and in the identification of carriers of SCT. People with SCT are for the most part asymptomatic and mainly identified as through genetic testing or when they have a child with SCD. This qualitative study explored perceptions towards genetic testing for SCD and SCT in Cameroon, Ghana, and Tanzania. The results show a general preference for newborn screening for SCD over prenatal and premarital/preconception testing, primarily due to its simpler decision-making process and lower risk for stigmatization. Premarital testing for SCT was perceived to be of low public health value, as couples are unlikely to alter their marriage plans despite being aware of their risk of having a child with SCD. Adolescents were identified as a more suitable population for SCT testing. In the case of prenatal testing, major concerns were centred on cultural, religious, and personal values on pregnancy termination. The study revealed a gender dimension to SCD/SCT testing. Participants mentionned that women bear a heightened burden of decision making in SCD/SCT testing, face a higher risk of rejection by potential in-laws/partners if the carriers of SCT, as well as the possibility of divorce if they have a child with SCD. The study highlights the complex cultural, ethical, religious and social dynamics surrounding genetic testing for SCD and emphasises the need for public education on SCD and the necessity of incorporating genetic and psychosocial counselling into SCD/SCT testing programs.

Evaluation of the telemedical health care network “SAFE BIRTH” for pregnant women at risk, premature and sick newborns and their families: study protocol of a cluster-randomized controlled stepped-wedge trial

BackgroundThe Perinatal Center of the University Hospital Carl Gustav Carus Dresden has initiated the telemedical healthcare network “SAFE BIRTH” to coordinate and improve specialized care in non-metropolitan regions for pregnant women and newborns. The network incorporates five intervention bundles (IB): (1) Multi-professional, inter-disciplinary prenatal care plan; (2) Neonatal resuscitation; (3) Neonatal antibiotic stewardship; (4) Inter-facility transfer of premature and sick newborns; (5) Psycho-social support for parents. We evaluate if the network improves care close to home for pregnant women, premature and sick newborns.MethodsTo evaluate the complex healthcare intervention “SAFE BIRTH” we will conduct a cluster-randomized controlled stepped-wedge trial in five prenatal medical outpatient offices and eight non-metropolitan hospitals in Saxony, Germany. The offices and hospitals will be randomly allocated to five respectively eight sequential steps over a 30-month period to implement the telemedical IB. We define one specific primary process outcome for each IB (for instance IB#1: “Proportion of patients with inclusion criterion IB#1 who have a prenatal care plan and psychosocial counseling within one week”). We estimated a separate multilevel logistic regression model for each primary process outcome using the intervention status as a regressor (control or intervention group). Across all IB, a total of 1,541 and 1,417 pregnant women or newborns need to be included in the intervention and control group, respectively, for a power above 80% for small to medium intervention effects for all five hypothesis tests. Additionally, we will assess job satisfaction and sense of safety of health professionals caring for newborns (questionnaire survey) and we will assess families’ satisfaction, resilience, quality of life and depressive, anxiety and stress symptoms (questionnaire surveys). We will also evaluate the cost-effectiveness of ”SAFE BIRTH” (statutory health insurance routine data, process data) and barriers to its implementation (semi-structured interviews). We use multilevel regression models adjusting for relevant confounders (e.g. socioeconomic status, age, place of residence), as well as descriptive analyses and qualitative content analyses.DiscussionIf the telemedical healthcare network “SAFE BIRTH” proves to be effective and cost-efficient, strategies for its translation into routine care should be developed.Trial registrationGerman clinical trials register. DRKS-ID: DRKS00031482.

Processing the process: Reflections on genetic counselor-led student supervision groups and practical tips for future facilitators.

Genetic counseling graduate students face growth and challenges across a variety of axes both personally and professionally throughout their training. The formation of leader-led supervision groups for second-year genetic counseling students has created a safe space for students to give and receive feedback, process their positionality in complex clinical scenarios and the medical system at large, dissect psychosocial counseling theory, and share personal and professional experiences with the overall aim of supporting their growth. This work requires faculty facilitators who are invested in student growth and operate from a framework of empathy, humanism, curiosity, and vulnerability. The authors share their reflections on stepping into the facilitator role with no prior experience other than their work in clinical genetic counseling in varied practice settings. Common themes across four cohorts of students are presented along with reflections on facilitator growth, consideration of student developmental stages, and the parallel process between providing clinical services to clients and educating students. The authors hope to highlight the value of processing cases, inspire other genetic counselors to engage in this work, and normalize the experiences of those already running genetic counseling student process groups.

Assessing the Nepalese health system's readiness to manage gender-based violence and deliver psychosocial counselling.

Violence against women (VAW), particularly intimate partner violence (IPV) or domestic violence, is a major public health issue, garnering more attention globally post-coronavirus disease 2019 (COVID-19) lockdown. Health providers often represent the first point of contact for IPV victims. Thus, health systems and health providers must be equipped to address survivors' physical, sexual and mental health care needs. However, there is a notable lack of evidence regarding such readiness in Nepal. This study, utilizing a concurrent triangulation design, evaluated the readiness of public health facilities in Nepal's Madhesh Province in managing VAW, focusing on providers' motivation to offer psychosocial counselling to survivors. A cross-sectional study was conducted across 11 hospitals and 17 primary health care centres, where 46 health care providers were interviewed in February-April 2022. The study employed the World Health Organization's tools for policy readiness and the Physician Readiness to Manage IPV Survey for data collection. Quantitative and qualitative data were collected via face-to-face interviews and analysed using descriptive and content analysis, respectively. Only around 28% of health facilities had trained their staff in the management of VAW. Two out of 11 hospitals had a psychiatrist, and a psychosocial counsellor was available in four hospitals and two out of 17 primary health care centres. Two-thirds of all health facilities had designated rooms for physical examinations, but only a minority had separate rooms for counselling. Though a few health facilities had guidelines for violence management, the implementation of these guidelines and the referral networks were notably weak. Hospitals with one-stop crisis management centres demonstrated readiness in VAW management. Health providers acknowledged the burden of IPV or domestic violence and expressed motivation to deliver psychosocial counselling, but many had limited knowledge. This barrier can only be resolved through appropriate training and investment in violence management skills at all tiers of the health system.