Seeking Health Services Research Articles

Stigma of nursing students towards people with mental illness: Protocol of a mixed‐method systematic review

AimsTo synthesize the influencing factors of the stigma of nursing students towards people with mental illness (PMI). BackgroundThe stigma of nursing students towards PMI may affect their career choices and negatively impact people seeking health services. While many studies have examined the educational aspects of mental health, they often overlook the multiple dimensions of possible factors influencing nursing students' perceptions. DesignA mixed‐method systematic review using the Framework Integrating Normative Influences on Stigma (FINIS). MethodsWe will search six databases, including PubMed, Web of Science, Cochrane Library, EMBASE, CINAHL and PsycINFO. The reference list of the included literature will be thoroughly examined to identify if any additional studies meet the criteria. Two authors will independently screen all titles, abstracts, full text and extract data. The Mixed-method Appraisal Tool will be used to assess quality. The extracted data will be disposed to different levels, including micro (demographic characteristics, disease characteristics), meso (social networks, treatment systems) and macro (media images, national context) to comply with the FINIS. Expected resultsThis systematic review aims to comprehensively analyze the influencing factors of the stigma of nursing students towards PMI, providing a reference basis for anti-stigma intervention measures.Prospero registration number: CRD42022374419.

"Emotional stress is more detrimental than the virus itself": A qualitative study to understand HIV testing and pre-exposure prophylaxis (PrEP) use among internal migrant men in South Africa.

South Africa has one of the highest rates of internal migration on the continent, largely comprised of men seeking labour in urban centres. South African men who move within the country (internal migrants) are at higher risk than non-migrant men of acquiring HIV yet are less likely to test or use pre-exposure prophylaxis (PrEP). However, little is known about the mechanisms that link internal migration and challenges engaging in HIV services. We recruited 30 internal migrant men (born outside Gauteng Province) during August 2022 for in-depth qualitative interviews at two sites in Johannesburg (Gauteng) where migrants may gather, a factories workplace and a homeless shelter. Interviewers used open-ended questions, based in the Theory of Triadic Influence, to explore experiences and challenges with HIV testing and/or PrEP. A mixed deductive inductive content analytic approach was used to review data and explain why participants may or may not use these services. Migrant men come to Johannesburg to find work, but unreliable income, daily stress and time constraints limit their availability to seek health services. While awareness of HIV testing is high, the fear of a positive diagnosis often overshadows the benefits. In addition, many men lack knowledge about the opportunity for PrEP should they test negative, though they express interest in the medication after learning about it. Additionally, these men struggle with adjusting to urban life, lack of social support and fear of potential stigma. Finally, the necessity to prioritize work combined with long wait times at clinics further restricts their access to HIV services. Despite these challenges, Johannesburg also presents opportunities for HIV services for migrant men, such as greater anonymity and availability of HIV information and services in the city as compared to their rural homes of origin. Bringing HIV services to migrant men at community sites may ease the burden of accessing these services. Including PrEP counselling and services alongside HIV testing may further encourage men to test, particularly if integrated into counselling for livelihood and coping strategies, as well as support for navigating health services in Johannesburg.

Enhancing Contraceptive Utilization among Females of Reproductive Age: Factors, Challenges, and Strategies at Jinja Regional Referral Hospital

The research aimed to assess the factors influencing the utilization of contraceptives among females of reproductive age seeking health services at Jinja Regional Referral Hospital. Specifically, it sought to establish socio-demographic characteristics, examine health service factors affecting contraceptive utilization, and determine its prevalence. A cross-sectional and descriptive research design employing both quantitative and qualitative methodologies was utilized to ensure the gathered information was representative of the population and captured at a single point in time. The study discovered a prevalence of contraceptive use among females of 55.7%, with short-term hormonal methods being the most common at 57.1%. Key findings revealed that females aged 18 to 30 years (57.1%) were significantly more likely to use contraception (p-value = 0.036), and multiparous individuals (98.2%) were more inclined to utilize contraception compared to para-one individuals (50.6%) (p-value = 0.024). Moreover, prior counseling (73.2%) significantly promoted contraceptive usage (p-value = 0.015). In conclusion, despite the observed prevalence, contraceptive utilization remained relatively low. Recommendations include increasing the availability of contraceptive services at lower-level health care centers to enhance accessibility, educating mothers visiting health facilities about contraceptive services, and addressing contraception-related phobias through counseling to encourage uptake among females. Keywords: Contraceptives, Females, Reproductive age, Health services, Health facility.

Managing hypertension in rural Gambia and Kenya: Protocol for a qualitative study exploring the experiences of patients, health care workers, and decision-makers

Background Hypertension is the single leading risk factor for premature death in Sub-Saharan Africa (SSA). Prevalence is high, but awareness, treatment, and control are low. Community-centred interventions show promise for effective hypertension management, but embedding sustainably such interventions requires a good understanding of the wider context within which they are being introduced. This study aims to conduct a systematic health system assessment exploring the micro (patients/carers), meso (health care workers and facilities), and macro (broader system) contexts in rural Gambia and Kenya. Methods This study will utilise various qualitative approaches. We will conduct focus group discussions with hypertensive patients to map a ‘typical’ patient journey through health systems. We will conduct in-depth interviews with patients, health care workers, and decision-makers to explore their experiences of managing hypertension and assess the capacity and readiness of the health systems to strengthen hypertension management in rural Gambia and Kenya. We will also review national guidelines and policy documents to map the organisation of services and guidance on hypertension diagnosis and control. Thematic analysis approach will be used to analyse data, guided by the cumulative complexity model, and theories of organisational readiness and dissemination of innovations. Expected findings This study will describe the current context for the diagnosis and management of hypertension from the perspective of those involved in seeking (patients), delivering (health care workers) and overseeing (decision-makers) health services in rural Gambia and Kenya. It will juxtapose what should be happening according to health system guidance and what is happening in practice. It will outline the various barriers to and facilitators of hypertension control, as perceived by patients, providers, and decision-makers, and the conditions that would need to be in place for effective and sustainable implementation of a community-centred intervention to improve the diagnosis and management of hypertension in rural settings.

Sexual and Reproductive Health Service Seeking Scale (SRHSSS): development, validity, and reliability

BackgroundYoung adults are a diverse group with diverse cares, choices and preferences in accessing and using Sexual and Reproductive Health (SRH) services, they should be at the center of the development of new managed models and solutions for the delivery of SRH services. The purpose of the study is to develop a valid and reliable measurement tool that can be used to determine the knowledge and attitudes of young adults about SRH and the barriers for accessing services, and to evaluate the attitudes and needs of young adults to receive SRH services.MethodsIn this study, the questions of the scale were developed through literature review, focus group interview with 8 people and expert evaluation were made, and a pre-test application was also carried out. Exploratory factor analysis and reliability testing were performed with a sample of 458 young adults. The re-test reliability was performed with 220 participants who were reached one month after the first measurement. Principal component analysis was used to establish the construct validity. The reliability of the scale was assessed using the Cronbach's alpha value.ResultsA 23-item scale has been developed to identify and evaluate young adults' thoughts, attitudes, and perceived barriers for accessing services regarding SRH. In the exploratory factor analysis conducted to examine the construct validity of SRHSSS, a four-factor structure was obtained that explained 89.45% of the total variance. The factor loadings of the scale items were found to vary between 0.78–0.97. At the same time, the Cronbach's alpha value of the scale is 0.90, indicates a good internal consistency.ConclusionsSRHSSS is a scale with sufficient validity and reliability to determine young adults' SRH Service Seeking.

Socio-Demographics Factors Influencing Parental Knowledge About Childhood TB

Knowledge is a fundamental aspect that can influence attitudes and behaviour in seeking parental health services and have an impact on reducing the scope of finding cases of TB in children. The eastern region of Bandung Regency is a densely populated area with a low socioeconomic level and has a high number of TB cases. Knowledge is known to be related to behavior in seeking health services and is one of the factors that influence the behavior of parents who have children with TB. This study aims to determine the relationship between socio-demographic factors that can influence parents' knowledge about TB in children. This research with a correlational descriptive design was carried out using purposive sampling with the criteria of a sample of parents who have children aged 0-14 years and are undergoing TB treatment in the eastern region of Bandung Regency in the 2020–2022-year range. The number of samples involved in this research was 54 people. The questionnaire used in this study was based on the Knowledge, Attitudes and Practice (KAP) survey guidelines developed by the World Health Organization. Bivariate data analysis was performed using contingency correlation test. Most parents already have good knowledge about TB (57.4%). Age (p=0.019) is a factor related to parents' knowledge about child TB. Unrelated factors were education (p=0.064), economy (p=0.425), and parents' occupation (p=0.272). The knowledge of parents who have children with a history of TB in the Eastern Region of Bandung Regency regarding childhood Tuberculosis is quite good. This can be influenced by aspects of education, economics, and parents' work. Health workers play a major role in increasing parental knowledge about child TB. Nurses as care givers and educators can involve parents in the process of caring for childhood TB patients and increase knowledge through education and health promotion about TB.

What preconception health services would the public find when searching the internet in Australia?: results from a simulated internet-search study

BackgroundAustralian preventive health strategy outlines the importance of preconception health in improving health in the community, across multiple generations and places primary and community healthcare services as a central pillar to effective preconception care. However, there is no national implementation plan to see preconception care proactively offered in healthcare settings in Australia. Instead, there is evidence that most women search the internet for information about pregnancy planning and preparation. In response, this study explores the availability and characteristics of health services found by searching for preconception care online in Australia.MethodSimulated Google searches were conducted using search terms ‘preconception’ and the name of a city/town with a population > 50,000. Related terms, ‘fertility’ and ‘pregnancy’ were also searched. Characteristics of the health services and the information available on relevant websites were extracted and reported descriptively.ResultsThe searches identified 831 website links, including 430 websites for health services. The health services were most often located in cities/towns with populations equal to or less than 200 000 (54.2%), and housing multiple health professionals (69.8%) including a specialist doctor (66.5%), nurse (20.9%), psychologist/counsellor (2.0%) and/or naturopath (13.0%). All the health services identified online explicitly mentioned women among their target populations, while 69.1% (n = 297) also referred to providing services for men or partners. More than one third of websites included blogs (36.9%) while external links were included in 10.8% of the online sites.ConclusionsThis study provides a preliminary examination of health services that may be found through internet-based searching by Australian consumers seeking health advice or support prior to becoming pregnant. Our descriptive results suggest couples may find a variety of health professionals when seeking health services for preconception care. Future research involving co-design of search terms with consumers, ongoing monitoring of health services and ensuring access to meaningful, and accurate information found through internet-searching are all necessary to ensure people of reproductive age are able to access the preconception health information and care they need.

Implementation of a Booster Sexual Health Education Curriculum for Older Adolescents in Rural Communities.

Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A "booster" round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

Knowledge, behavior and practices of the population during the pandemic against the transmission of SARS-CoV-2 in the state of Alagoas, Brazil.

The World Health Organization (WHO) declared an international state of emergency in order to contain the rapid spread of COVID-19. To ensure that there is adherence to preventive measures by the population aimed at controlling the pandemic in Alagoas, it is expected that knowledge, behavior and practices play an important role in preventing and controlling the disease. In this sense, it becomes relevant to understand the knowledge of the population about the disease. To evaluate the knowledge, behavior and practices of social media users during social isolation to prevent the transmission of the SARS-CoV-2 in the state of Alagoas, Northeast, Brazil. A probabilistic sample was carried out across the entire territory of the state of Alagoas with those who have access to a device that accesses the internet and a cross-sectional study was carried out using an online questionnaire applied to a convenience sample, recruited between August 2021 and July 2022 by snowball sampling. The questionnaire consisted of seven sessions, the first collecting data on the socioeconomic and sociodemographic profile of the participants, and the other sessions involving knowledge, attitudes and practices, including topics related to the vaccination that had to be administered at that time. High popular knowledge about signs and symptoms, means of transmission and risk groups. Low knowledge about seeking health services. Based on the results obtained, information from official channels became relevant to better teach the population in order to reduce the impact of COVID-19.

Lifetime sexual violence among transgender women and travestis (TGW) in Brazil: Prevalence and associated factors.

To describe the prevalence, characteristics, and factors associated with sexual violence in transgender women and travestis (TGW) in Brazil. This cross-sectional study was conducted in five Brazilian cities (Campo Grande, Manaus, Porto Alegre, Salvador, and São Paulo) between 2019 and 2021. Participants were recruited using the respondent-driven sampling (RDS) technique. The outcome of interest is the self-reported experience of sexual violence throughout the respondents' lifetime. We evaluated the actions taken by victims of sexual violence and how they dealt with the experience. Logistic regression analysis was employed to examine the associations between sociodemographic and behavioral factors (such as race, income, drug use, sex work, and access to healthcare) and the outcome. A total of 1,317 TGW were interviewed. Among them, 53% (n=698) reported experiencing sexual violence. For 64.4% (n=419) of the respondents, sexual violence occurred on more than one occasion. The majority of TGW did not seek health services (93.2%, n=648), disclose the violence (93.9%, n=653), nor seek support from family or friends (86.5%, n=601). A higher prevalence of sexual violence was associated with homelessness (adjusted prevalence ratio - aPR=1.69, 95% confidence interval - 95%CI 1.01-2.84), a history of engaging in sex work (aPR=2.04, 95%CI 1.46-2.85), self-reporting regular, bad, or very bad emotional health (aPR=1.67, 95%CI 1.28-2.19), and experiencing difficulties accessing health services in the previous year (aPR=2.78, 95%CI 1.74-4.43). The high prevalence of sexual violence, analyzed together with the actions of the victims, indicates a context of high vulnerability and low institutional support. In this scenario, violence can be exacerbated, resulting in severe health consequences.

Overview of long COVID in Brazil: a preliminary analysis of a survey to think about health policies

Characterized by symptoms that remain or appear for the first time within three months of SARS-CoV-2 infection, long COVID can manifest itself in different ways, including in non-hospitalized or asymptomatic cases. Thus, this study offers an overview of long COVID in Brazil, especially of its diagnosis, symptoms, and challenges for new health management. Data from a study that investigated long COVID in people affected by COVID-19 were used. These original data stem from a survey with adult Brazilians (aged 18 years or older) who had COVID-19 that collected information from March 14 to April 14, 2022, by a questionnaire on social media. The questionnaire addressed sociodemographic characteristics, history of COVID-19 infections, vaccination against the disease, investigation of health status and quality of life before and after COVID-19, and search and access to treatment. Of the 1,728 respondents, 720 were considered eligible for analysis, of which 496 (69%) had long COVID. Individuals with long COVID reported clinical manifestations such as anxiety (80%), memory loss (78%), generalized pain (77%), lack of attention (75%), fatigue (73%), hair loss (71%), sleep changes (70%), mood swings (62%), malaise (60%), and joint pain (59%). Most sought health services during and after the acute phase of COVID-19 (94 and 80%, respectively), representing the need to structure the healthcare system for these patients.

Supplemental Material for Emergency Psychiatric Assistance: Black Individuals’ Perceptions of Police and Other Factors That Influence Mental Health Service Seeking

Supplemental Material for Emergency Psychiatric Assistance: Black Individuals’ Perceptions of Police and Other Factors That Influence Mental Health Service Seeking

Perceptions and attitudes of black Sub-Saharan African migrants from war-torn zones towards accessing health services in the English West Midlands region, UK

Purpose The purpose of this paper is to explore the experiences of black Sub-Saharan African (BSSA) migrants from war-torn zones in accessing health services in the West Midlands region of the UK. This may help to inform on factors influencing the uptake of health services for new migrant communities. Design/methodology/approach This study explored the experiences of BSSA migrants from war-torn zones in accessing health services in the West Midlands using an explorative qualitative approach. Ten focus groups made up of seven participants each were followed up with three in-depth one-to-one interviews from each focus group using a conversational approach where research participants were encouraged to direct and shape the discussion in accordance with their own experiences, views and particular concerns (Kvale, 1996) as opposed to responding to a pre-determined agenda. Findings Following transcription, coding and analysis of the focus group discussions and follow-up interviews, this study found that perceptions and attitudes of BSSA communities in accessing health services included difficulties in navigating the health system, intrusive and embarrassing questions from clinicians, stigmatisation through offering an HIV test, culturally unfriendly counselling support, unconfidently services and episodes of trauma flashbacks. Originality/value The experiences of BSSA migrants who sought health services in the West Midlands in the UK demonstrated important implications for future practice and informed service delivery. There is a need to consider cultural education for both BSSA migrants and health professionals to enhance understanding and trust between the groups. Basic professional training for health professionals should also encompass the needs of the growing ethnic populations in the UK.

Exploring cross-cultural perspectives on adolescent mental health among Congolese immigrant adults in the USA and Belgium

Purpose This paper aims to explore the intersection of cultural processes and immigration in parental understanding of adolescent mental health and mental health seeking behaviors among African immigrants in Western countries. The present study examines the perspectives of Congolese immigrant parents on adolescent mental health in Brussels, Belgium, and Raleigh, North Carolina, USA – two geographic regions with relatively large Congolese migrant populations. This study highlights a needed understanding of cultural and acculturative context in shaping the beliefs of Congolese immigrants and explores potential barriers of seeking health services. Additionally, it recognizes health issues among this underrepresented and underserved population. Design/methodology/approach Fifteen Congolese immigrant parents, eight in the USA and seven in Belgium, participated in structured qualitative interviews using an adapted version of Kleinman Questions and behavioral scenarios on depression, post-traumatic stress disorder and oppositional defiant disorder. Interviews were audio recorded, and participants were assigned pseudonyms to de-identify responses. English interviews were transcribed verbatim by a trained team of undergraduate research assistants, and French interviews were transcribed verbatim by the first author and a graduate research assistant. Following transcription, the first and second authors used a rapid analytic approach (Hamilton, 2013). The first and second authors conducted a matrix analysis to observe thematic patterns. Findings Parents interpreted adolescent behavior to be more problematic when the scenarios were overtly outside of their cultural realm of values and beliefs. Parents preferred methods of intervention through religious practices and/or family and community efforts rather than seeking mental health services in their host countries as a secondary option. The authors’ findings provide an understanding of the values and beliefs of this underrepresented demographic, which may be useful to guide health professionals on how to support this community in a culturally responsive way. Research limitations/implications Limitations to the current study include the structured nature of the interview guide that did not allow for in-depth qualitative exploration. Interviewed participants had lived in their host countries for more than 10+ years. Thus, the authors’ findings are not reflective of new immigrants’ experiences. Parents’ perspectives were likely shaped by exposure to Western beliefs related to support for mental health (e.g. knowledge of psychologists). Future studies should focus on recent refugees due to exposure to traumatic events and experiences reflective of the Democratic Republic of Congo’s (DRC’s) current socio-political situation, and how these are understood in the context of adolescent mental health. Further, due to the hypothetical nature of the scenarios, the authors cannot be sure that participants would engage in the identified approaches with their children. Additionally, hearing from the youth’s perspective would provide a clearer insight on how mental health and seeking professional help is viewed in a parent–child relationship. Finally, the data for this study were collected in 2019, prior to the COVID-19 pandemic. Although the authors cannot speak directly to Congolese refugee and immigrant experiences during this significant historical period, given the rise in mental health concerns in refugee populations more broadly (Logie et al., 2022), the authors’ findings speak to how parents may have responded to increased mental health symptoms and point to additional barriers that these populations may have faced in accessing support. The authors’ study emphasizes the need for dedicating resources and attention to this population, especially the development of culturally tailored messaging that invites community members to support the mental health needs of their community. Practical implications The authors’ findings provide important implications for mental health professionals. This study provides a clearer understanding of how Congolese immigrant parents view mental health and help-seeking within their cultural frame. Although parents may seek professional help, a distrust of mental health services was expressed across both cohorts. This suggests that mental health professionals should acknowledge potential distrust among this population and clarify their role in supporting the mental health of adolescent immigrants. Clinicians should inquire about familial cultural beliefs that are parent- and child-centered and modify their interventions to fit these belief structures. Originality/value This paper addresses the gap in knowledge about mental health perspectives of Sub-Saharan African immigrant populations, specifically those from the DRC.

Examining healthcare needs and decisions to seek health services among Venezuelan migrants living in Trinidad and Tobago using Andersen's Behavioral Model.

Beginning in 2016, Trinidad and Tobago experienced increasing flows of migrants and refugees from Venezuela. Through a Government Registration Exercise in 2019, followed by a Re-registration Exercise in 2020, migrants and refugees benefitted from access to publicly available primary care and emergency medical services. By applying Andersen's Behavioral Model for Health Service Use, our study examined the non-communicable disease care needs of migrants, and factors influencing their decision to seek public and private health services. Between September and December 2020, a health questionnaire was administered via telephone to n = 250 migrants from Venezuela. Descriptive statistics summarized the constructs of Andersen's Behavioral Model. The model comprised of predisposing factors including migrants' social characteristics; enabling factors namely monthly earnings, education level and most trusted source of information on medical needs; need for care factors such as migrants self-reported health status, presence of non-communicable health conditions and having visited a doctor in the past 12 months; and the outcome variables which were migrants' decisions to seek public and private health services. Pearson χ2 tests, odds ratios and multivariable logistic regression with backward elimination examined the factors influencing a migrant's decision to seek health services. Overall, 66.8% of migrants reported they would seek public health services, while 22.4% indicated they would seek private health services. Predisposing factors namely length of time residing in Trinidad and Tobago (p = 0.031) and living with family/friends (p = 0.049); the enabling factor of receiving information from publicly available sources (p = 0.037); and the need for care factor of visiting a doctor for a physical health problem (p = 0.010) were significant correlates of their decision to seek care in the public sector. Predisposing factors namely living with family/friends (p = 0.020) and the enabling factor of having difficulty accessing healthcare services (p = 0.045) were significant correlates of their decision to seek care from private providers. Our findings demonstrated the positive association between social networks and a migrant's decision to use public and private health services, thus underscoring the importance of family and friends in facilitating health service use, promoting proper health practices and preventing diseases. Overall, the use of Andersen's Behavioral Model aided in identifying the factors associated with the use of health services by Venezuelan migrants in Trinidad and Tobago. However, further studies are needed to better understand their need for ongoing care, to inform policy, and to plan targeted health interventions for addressing the gaps in health service access, barriers and use.

Access to primary healthcare services by people with disabilities

Objective: to analyze the access of people with hearing, physical, and visual disabilities to primary healthcare services. Methods: a cross-sectional study was conducted with 250 participants, and data collection was implemented in three stages: contact with the health department, locating the residences of persons with disabilities within the coverage area of the primary healthcare unit, and analysis of integrated data. Results: there was a predominance of older individuals, individuals of non-white race/ethnicity, males, and those who were either married or in a consensual union. Self-transportation, including cars, motorcycles, or bicycles, was the primary means of access to services, followed by walking. Most individuals sought health services within six months, followed by those who sought care between six months and one year, mainly because of chronic or worsening conditions. Conclusions: impaired access was identified, as evidenced by multiple barriers, including transportation, architectural, and communication barriers. Contributions to practice: it is important to consider the disparities, vulnerabilities, and health status of the disabled population in health care.

The effect of a tailored message package for reducing antibiotic use among respiratory tract infection patients in rural Anhui, China: a cluster randomized controlled trial protocol

BackgroundAntibiotics are over-used for patients with respiratory tract infections (RTIs) in primary care, especially in the rural areas of China.MethodsA cluster randomized controlled trial (RCT) will be carried out to estimate the effectiveness of a tailored message package for educating patients to reduce antibiotic use for symptomatic respiratory tract infections (RTIs). In the intervention group, patients will receive 12 short messages in 12 consecutive days. The whole process of the message design, modification, translation (of substitution variables), and sending will be facilitated by a user-friendly mini-computer program. The primary measure for assessment is the reduction in number of days in which antibiotics are used by patients with symptomatic RTIs. The secondary measures include (1) patients’ knowledge about and attitude toward antibiotics; (2) patients’ quality of life (EQ-5D-5L) and symptom severity and duration; (3) times of re-visits to clinics and antibiotics re-prescription for the same RTI episode; and (4) times of re-occurrence of RTIs and related health service seeking and antibiotics consumption.DiscussionThis study will determine the efficacy of a 12-message intervention to educate patients to reduce excessive antibiotic use in rural China.Trial registrationISRCTN29801086. Registered on 23 September 2022.

Knowledge, Perceptions and Practices of Adults towards Dementia at a Selected Hospital in Lesotho

Objective: This study aimed to determine knowledge, perceptions and practices towards dementia in adults seeking health services at a selected hospital in Lesotho. Method: The descriptive quantitative research design was used in conducting the study. A sample of 52 participants were selected using convenience sampling method. Data was collected using pre-tested semistructured questionnaire written in both English and Sesotho languages. Data was analyzed through the use of Microsoft Excel, presented on frequency tables, pie charts and bar charts. Results: The study results revealed that there is dearth of knowledge towards dementia (27%), majority of participants (n=26) had insufficient knowledge towards dementia. On the perception, 26.9% strongly perceived dementia as witchcraft and 34.6% of participants disregard dementia as part of the aging process. As much as majority of participants (63.5%) reported that demented people should be hospitalized, 13.5% of adults still believed that demented people should seek prophetic help. Conclusion: It can be concluded that there is need to raise awareness regarding mental health such as dementia so that affected individuals and families may be supported accordingly.

Relationship between Attendance of ANC and labour Complications among Mothers who delivered at Fort Portal Regional referral Hospital

Appropriate antenatal care (ANC) is key for the health of the mother and child. Globally, approximately 515,000 women die from pregnancy-related complications each year. It has been estimated that 25 percent of maternal deaths occur during pregnancy, with variability between countries depending on the prevalence of unsafe abortion, violence, and disease in the area. This study focused on the relationship between attendance of ANC and gestational or labor complications among mothers who delivered at Fort Portal Regional Referral Hospital (FPRRH). A cross-sectional study was conducted whereby quantitative data was acquired using participant self-administered questionnaires, investigator administered questionnaires. A total of 323 mothers were randomly sampled from the population using the convenience sampling technique. Results are depicted in 95% Confidence Intervals, Odd Ratios (OR), and P-values; all calculated using Binary Logistic Regression with Pearson’s correlation in the Statistical Package for Social Sciences. Graphical representation was done by Microsoft Excel Software. A total of 323 mothers were studied with a response rate of 91.02%. Results based on 294 participants show that 70(23.7%) of the mothers studied were in the age range of 15-25 years, majorly 170(57.8%) were 26-35 years, 54(18.5%) were 36-45 years; of these 33(11.1%) were single, 171(58.2%) were married, 55(18.6%) were separated and 36(12 %) were widows; 39(13.2%) attained primary level of education, 117(39.8%) secondary, 88(29.8%) tertiary, and 51(17.2%) were university graduates; 40(13.5%) were casual laborers, majority 208(70.8%) self- employed, and 46(15.7%) were civil servants. The study showed that the overall attendance of ANC among mothers in Fort Portal FPRRRH was low. This trend was shown to be significantly associated with a number of factors. Intensive health education and awareness campaigns on the importance of ANC should be done to equip mothers with the knowledge so as to reduce the burden of pregnancy-related complications. More effort must be applied to spreading awareness about proper health service seeking by mothers. Keywords: Antenatal care, Pregnancy, Maternal mortality, Labour, Health facilities

A theory of cultural translation in healthcare for multilingual older adults living with dementia and their caregivers

Objective: The United States is a multicultural, multilingual country; as a recognized feature of the American population, the challenges of caregivers seeking services for multilingual older adults still need to be better understood. This study aims to understand the experience of caregivers who sought healthcare services for a multilingual older adult living with dementia.Methods: Using Constructivist Grounded Theory, formal and informal caregivers participated in semi-structured interviews to ascertain their experiences seeking health services for multilingual older adults with dementia.Results: Several themes emerged, including Cultural Translator, Mitigating Relationships, Leaning, Seeking Help, Meeting them where they are, and a Rigid Healthcare System. Lastly, the participants’ descriptions unveiled a phenomenon identified as cultural translator stress. Cultural Translator stress may occur due to the added responsibilities of advocacy, healthcare system navigation, language interpretation, and explanations of culturally based idioms on behalf of the multilingual older adult with dementia for the healthcare provider.Conclusions: As our understanding of care for multilingual older adults with dementia improves, awareness of their caregiver's needs and mechanisms to support this unique population should emerge. Factors such as culture, access to culturally appropriate services, and services needed to support family caregivers are needed. Further studies are needed to understand the stressors related to caring for a multilingual adult living with dementia or the phenomenon of cultural translator stress.