Uptake Of Services Research Articles

Abstract C178: Uptake of prostate cancer screening services in men living with HIV in Trinidad and Tobago

Abstract Background: Compared to other groups, Black men have a higher incidence and mortality of prostate cancer (PCa). Worldwide, the Caribbean region has one of the highest age-standardized PCa incidences with 76 cases per 100,000 population per year. PCa incidence in predominantly Afro-Caribbean countries ranges from 160 in Barbados to 304 men diagnosed per 100,000 in Jamaica. In Tobago, 10% of adult men over 40yrs were found to be diagnosed with PCa. Additionally, men living with HIV (MLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. Thus, in the Caribbean, there is a pressing need for clinic-based PCa screening in MLWH. Objective: A preliminary quality improvement evaluation of a prostate cancer screening (PSA test) program targeting MLWH in Trinidad and Tobago from January 2019 to May 2024. Methodology: The electronic health information system from a large clinic was used to abstract prostate cancer screening (PSA) delivery. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. According to NCCN guidelines, since most of our patients were Afro-Caribbean or Mixed, this study treated all MLWH aged < 75yrs as men with high risk and used 3 ng/mL as the threshold; the threshold was 4 ng/mL for MLWH >75yrs. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: Between January 2019 and May 2024, a total of 2,442 MLWH were eligible to participate in the PSA screening clinic. The average age was 54.0 (age range: 40- 90). 62.9% were Afro-Caribbean, 17.6% were Mixed, 7.4% were East Indian/Indian, and 0.6% were Caucasian. 45.6% of MLWH completed at least secondary education. 26.2% reported having steady partners and 82.5% reported their sexual orientation was heterosexual. Among all MLWH who attended the clinic, 2,127 (87.1%) were referred for PSA tests and 1,640 (77%) MLWH received their PSA tests. For PSA results collected from participants aged 40-75, 86.6% were ≤ 3 ng/mL and 13.4% were > 3 ng/mL. Additionally, among PSA results of participants aged over 75, 51.9% were < 4 ng/mL and 48.1% were ≥ 4 ng/mL. Discussion: To the best of our knowledge, this study is the first of its kind in the Caribbean region. Among MLWH, PSA screening rate was relatively high at 77%. Not too surprising, the PSA results showed 13% of men under 75 and almost 50% of men over 75 had elevated PSAs requiring confirmatory screening and follow-up. Hence, we conclude that a whole-person care approach that includes cancer prevention with prostate cancer screening can be effective. We thus recommend an implementation and dissemination science approach to create strategies for adopting, implementing, sustaining, and disseminating clinic-based prostate cancer-related prevention to reduce related morbidity and mortality among MLWH within the Caribbean and the Americas. Citation Format: Jonathan Edwards, Gaole Song, Gregory Boyce, Selena Todd, Sharon Soyer, Tessa Galindo, Kimlin Ashing, Jeffrey Edwards. Uptake of prostate cancer screening services in men living with HIV in Trinidad and Tobago [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C178.

Abstract C152: Improving Access to Genetic Services for Women with Breast Cancer from Underserved Communities in California: Design and Implementation of a Community- Engaged Program

Abstract This study aims to understand the barriers to genetic services uptake at the patient, provider, and healthcare system levels, and to develop a multi-level intervention to increase access and suitability to genetic services for women from minority and medically underserved populations in California who have been recently diagnosed with breast cancer. Germline-informed cancer screening has been found to improve breast cancer survival and help identify close relatives who may have an inherited mutation that increases their susceptibility to cancer. However, only 26% of women diagnosed with breast cancer reported having germline genetic testing; marginalized populations are less likely to receive these services (Kurian et al., 2023). Using Levesque’s Conceptual Framework (Lévesque et al., 2013) and Implementation Mapping (Fernández et al., 2019), we are iteratively developing a multi-level program to explore the role that Community Health Workers (CHWs)/Promotoras can play in reducing access disparities to genetic services. Eleven CHWs/Promotoras have completed 80 hours of CHW training, 7 hours of mental health, insurance and group facilitation training, and 14 hours of cancer health training. CHWs/Promotoras have established local community breast cancer groups in their local communities across California’s Central Valley and are participating in and organizing breast cancer health fairs in their communities in partnership with Community Based Organizations (CBOs). Identifying and addressing the barriers to genetic services is critical to reducing access disparities to genetic services for underserved populations. CHWs/Promotoras are a promising resource to help reduce existing disparities in genetic services for women diagnosed with breast cancer. Citation Format: Iñigo Verduzco Gallo, Nanci Chavarria Villa, Angelica Rolon, Guadalupe Carvajal, Ana P. Estrada-Florez, Luis G Carvajal-Carmona. Improving Access to Genetic Services for Women with Breast Cancer from Underserved Communities in California: Design and Implementation of a Community- Engaged Program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C152.

Spatial patterns and associated factors of HIV testing and counselling (HTC) as a component of antenatal care services in Ethiopia

Background While HIV testing and counselling play a crucial role in preventing mother-to-child transmission, numerous pregnant women did not receive these services. Understanding the spatial variation of HIV testing and counselling and its associated factors during antenatal care in Ethiopia remains limited. Thus, this study was aimed at assessing the spatial patterns and factors associated with HIV testing and counselling during antenatal care visits in Ethiopia. Methods A cross-sectional study design was employed with a two-stage stratified cluster sampling technique. A total of 2,789 women who gave birth in the two years prior to the survey and had at least one antenatal care visit were included in the study. Stata version 16 and ArcGIS version 10.8 software were used for analysis. A multilevel robust Poisson regression model was fitted to identify significantly associated factors since the prevalence of HIV testing and counselling was higher than 10%. A statistically significant association was declared based on multivariable multilevel robust Poisson regression analysis using an adjusted prevalence ratio with its 95% confidence interval at a p-value < 0.05. Spatial regression analysis was conducted, and the local coefficients of statistically significant spatial covariates were visualised. Results In Ethiopia, the overall prevalence of HIV testing and counselling during antenatal care visits was 29.5% (95% CI: 27.8%, 31.2%). Significant spatial clustering was observed (Global Moran’s I = 0.138, p-value <0.001). In the spatial regression analysis, high and comprehensive knowledge related to HIV, and comprehensive knowledge on the prevention of mother-to-child transmission were significant explanatory variables for the spatial variation of HIV testing and counselling. In the multivariable multilevel robust Poisson regression analysis, education, household wealth, media exposure, number of antenatal care visits, comprehensive knowledge on mother-to-child transmission, comprehensive knowledge on prevention of mother-to-child transmission, and region were significantly associated factors. Conclusion The prevalence of HIV testing and counselling during antenatal care visits was low. Empowering women through education, promoting mass media exposure, increasing numbers of antenatal care visits, and enhancing women’s knowledge related to HIV and mother-to-child transmission by targeting cold spot areas could improve HIV testing and counselling service uptake among pregnant women in Ethiopia.

Drug problems and treatment services at the community level: findings from a national sample of key informants in Nigeria

ABSTRACT Aims This study aimed to provide community-level perspectives on substance use, related health and social harms and utilization of treatment for substance use disorders in Nigeria. Methods The study is based on descriptive-qualitative data from semi-structured interviews with a purposive sample of 2,787 key informants (e.g. police officers, health workers) from the 36 states of Nigeria. Results The findings highlight social, economic, legal, academic, occupational and health problems linked to drug consumption. Drug-related problems extended beyond individuals who consume drugs to impact close relations and local communities. Government-funded facilities (e.g. general hospitals, specialist psychiatric facilities) were thought to be more available, accessible and acceptable to people seeking treatment for substance use disorders than other types of facilities (e.g. faith-based facilities, NGO treatment centers). The provision and uptake of services in these facilities are constrained by financial cost and inadequate specialist services for drug use owing to shortage of skilled professionals. Conclusion There exist a need to improve access to substance use disorder treatment through development of skilled manpower, expansion of health service coverage and strengthening of community-based services. Further, prioritizing healthcare services and combating stigma against people who use drugs could contribute to uptake of services.

The “Latines Lideres En Salud (LaLiSa)” study: Rationale and design

BackgroundLatines suffer from breast cancer (BC), due to elevated biological and social determinants of health (SDOH) risks. This study compares the effects of different strategies on uptake of cancer genetic services, specifically hereditary cancer risk assessment, genetic counseling, and genetic testing, and risk-based BC care. Design/methodsIn Chicago, Illinois, Aim 1 participants are recruited from a federally qualified health center (FQHC) and community venues. For Aim 1, eligible participants: (1) are female; (2) are Latine; (3) are 30+ years old; (4) have personal or family history of BC or cancers with shared hereditary mutations; (5) have at least one SDOH risk; and (6) have not received any cancer genetic services. Participants are randomly assigned to different study arms. Both arms include phone-based sessions, FQHC-based navigation for SDOH, and low- or no-cost cancer genetic services. The educate sessions focus on risk assessment and prevention. The empower sessions focus on risk assessment and equip participants with the skills to share information about FQHC-based cancer genetic services. For Aim 2, eligible participants are: (1) female; (2) network members of Aim 1 participants; and (3) eligible for BC screening based on guidelines recommended by the American Cancer Society (ACS). Primary outcomes include uptake of any cancer genetic services. Analyses will also explore intervention differences by neighborhood context. DiscussionThis is one of the first trials focused on Latines' participation in cancer genetic services and risk-based BC care within the context of SDOH - which has major implications for equity in precision cancer prevention.

Understanding how community-dwelling persons with early dementia perceive health and community services: Informing the dementia strategy of Newfoundland and Labrador, Canada.

With an increased aging population, the number of individuals with dementia is expected to rise. The onset of dementia marks the start of negotiating access to a wide range of health and social services to find practical and emotional supports to deal with the management of changes and subsequent challenges that individual with dementia face. The toll of dementia goes beyond the health care system, affecting families and caregivers' quality of life. This places more pressure on family caregivers and health care institutions to provide services for affected individuals. It is important to understand the service needs of this population to enable them to live at home longer, contribute to society and maintain a positive quality of life. To increase understanding of how persons living at home with early dementia and their caregivers/significant others currently perceive and interact with health and community-based services and service providers. A qualitative descriptive approach was used to explore the experiences of individuals with early dementia and care providers with health and community-based services using semi-structured interviews and content analysis. Participants included 16 individuals 50years and older with mild/early dementia living at home, 22 informal caregivers of individuals with mild/early dementia, and 5 key community informants (community health nurses and social workers). Four thematic categories of barriers and two thematic categories of facilitators for access to and uptake of supportive services were identified. Five strategies to inform the development of an action plan to enhance access to, and uptake of, supportive services were determined. Early recognition of dementia through education and publicity enhanced public awareness, attention, and social inclusion with dementia-friendly neighborhoods and facilities need to be considered to achieve effective dementia-related services. Inclusion and recognition of the wishes of persons with dementia is key.

Virtual Service Delivery in Mental Health and Substance Use Care: A Systematic Review of Preference Elicitation Studies.

Mental health and substance use disorders affect the lives of many people worldwide. Prevention and treatment of these conditions is important for optimal health and wellbeing, yet service access barriers are common. Virtual models of care may help to reduce barriers to receiving care. However, to facilitate uptake and use of virtual services, they need to appeal to patients and clinicians. This systematic review aimed to synthesise preference elicitation studies to determine what features of virtual mental health and substance use care are preferred by service users and service providers. Following the PRISMA guidelines for systematic reviews, we searched PubMed, PsycINFO, EconLit, MEDLINE, CINAHL, Academic Search Ultimate, and ProQuest Central for all available studies from database inception until May 2023. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Nineteen studies met the eligibility criteria. However, none examined preferences for elements of different models of virtual care. Across the included studies, we identified 41 unique features that mapped to four themes of mental health and substance use care ('service', 'treatment', 'clinician' and 'additional supports'). Participant preferences were for individual, in-person, effective, flexible, and low-cost treatment. These preferences varied based on demographic factors, such as culture, gender, and participant type (e.g., patients, clinicians, general population). A user-centred approach should be adopted when designing and implementing mental health and substance use services. While preferences for features of mental health and substance use services more broadly are known, preferences for different models of virtual care remain unexplored. Future research should examine what features of virtual services would lead to optimal uptake and use across different users and stakeholders.

Preferences for sexual health services among middle-aged and older adults in the UK: a discrete choice experiment

ObjectivesSexual health is an integral part of well-being. However, the sexual health needs and desires of middle-aged and older adults have been largely disregarded. Therefore, this study aimed to understand...

Meeting Social Needs in a Crisis Context: Lessons Learned from Integrating the 'Take Care Initiative' into New York City's Testing and Contact Tracing Program.

The COVID-19 pandemic highlighted the importance of addressing social needs in a crisis context. Some US jurisdictions integrated a social service component into case investigation and contact tracing (CI/CT) programs, including the New York City (NYC) Test & Trace (T2) Program; the Take Care initiative referred NYC residents who tested positive or were exposed to COVID-19 to services to support isolation and quarantine and meet basic needs. More research is needed to determine effective implementation strategies for integrating social needs provision into CI/CT programs. To identify barriers and facilitators to the implementation of the Take Care initiative, we conducted key informant interviews with program staff, community-based organization partners, and cases and contacts as part of a larger evaluation of the T2 program. Interviews were recorded, transcribed, and analyzed using rapid qualitative methods. Key facilitators to implementation included utilizing a case management software system, employing strategies to encourage service uptake, leveraging cross-agency collaborations, and partnering with community-based organizations for resource navigation. Barriers identified included external management of the software system, challenges reaching and engaging the public, administrative complications due to shifting collaborations, and management of CBO partners' structure and hiring. Based on our findings, we provide recommendations to support effective planning and implementation of social needs service provision in a crisis context. Future research should focus on testing promising implementation strategies highlighted in this study and applying them to varied contexts and crisis situations.

Barriers to Childhood Immunisation and Local Strategies in Four Districts in South Africa: A Qualitative Study.

Introduction: In South Africa over the past 20 years, immunisation has saved countless lives as well as prevented illnesses and disabilities. Despite this, vaccine-preventable illnesses remain a danger. The demand for and uptake of immunisation services are shaped by a variety of factors that can either act as barriers or facilitators to immunisation uptake. The aim of this project was to identify the supply and demand barriers and develop local strategies to improve childhood immunisation in four zero-dose districts in South Africa. Materials and Methods: This study used a mixed-method approach. In each of these four districts, 15 in-depth key informant interviews with health workers and local health managers and four focus group discussions (10 participants per focus group discussion) with community members and caregivers were held over a three-month period. Transcribed interviews were thematically analysed using qualitative analysis software (Nvivo®) into 10 factors as identified as important in influencing immunisation demand and uptake in previous studies. A further four were identified during the data analysis process. Results: Despite the varying role of factors affecting demand and uptake of immunisation services, three consistent findings stand out as major barriers across all districts. The first is interaction with healthcare staff. This clearly highlights the crucial role that the interactions between patients and staff play in shaping perceptions and behaviours related to immunisation services. The second is the overall experience of care at healthcare facilities. This emphasises the role that patient experience of services plays in perceptions and behaviours related to immunisation services. The third is family dynamics. This highlights the important role family dynamics play in shaping individuals' decisions regarding immunisation uptake as well as the impact it has on the ability of people to access health services. Discussion: The role played by the different factors in the demand and uptake of immunisation services varied across the four districts examined in this study. Each of the districts presents a unique landscape where different factors have varying degrees of importance in affecting the utilisation of immunisation services. In some districts, certain factors are major barriers, clearly hindering the demand and uptake of immunisation services, while in others, these same factors might be a relatively minor barrier. This discrepancy highlights the unique nature of healthcare challenges across the districts and the need for tailored strategy recommendations to address them effectively.

Stated preferences of adolescents and young adults for sexual and reproductive health services in Africa: a systematic review protocol

BackgroundAdolescence and young adulthood are critical life stages with varied healthcare needs. Adolescents and young adults (AYAs) are often confronted with challenges in their sexual and reproductive health (SRH) and...

Barriers and facilitators of cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda: a qualitative study using the integrated model of health literacy

BackgroundSeveral rural public health facilities in East Central Uganda have sub-optimal, below 50%, levels of uptake of cervical cancer screening services among women with HIV. This is attributed to low cervical cancer screening literacy: limited ability to access, understand, appraise, and apply cervical cancer screening information. This research identified multi-level (health facility, community, interpersonal and individual) barriers, and facilitators of accessing, understanding, and applying cervical cancer screening information among rural women with HIV attending rural public health facilities in East Central Uganda to inform interventions.MethodsWe conducted ten Focus Group Discussions with rural women aged 25–49 years with HIV attending four selected rural public health facilities: thirty women who had ever screened for cervical cancer and thirty women who had never screened for cervical cancer across different age categories. Data was collected using a guide based on the Integrated model of health literacy. Thematic analysis was used for analysis. Competences (accessing, understanding and applying cervical cancer screening information) and categories of factors (health system, community, interpersonal and individual factors) of the integrated model of health literacy were deductively derived whereas barriers and facilitators were deductively derived from women’s statements.ResultsLack of communication materials and inability to access information were health facility and individual barriers of accessing cervical cancer screening information respectively. Facilitators of accessing information were access to information at health facility, community, and interpersonal levels and women’s ability to access information. Barriers and facilitators of understanding cervical cancer information were related to communication materials, provision of health education and women’s concentration during health education. Barriers and facilitators of applying cervical cancer screening information were related to communication and provision of cervical cancer screening services at health facility level, and interpersonal level from peers, partners and other family members as well as women’s ability to: understand information and access to cervical cancer screening services at individual level.ConclusionsThis study emphasizes the influence of multi-level factors on cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda. Improving uptake of cervical cancer screening services among these women requires multi-level interventions.

Uptake of Cancer Genetic Services for Chatbot vs Standard-of-Care Delivery Models: The BRIDGE Randomized Clinical Trial.

Increasing numbers of unaffected individuals could benefit from genetic evaluation for inherited cancer susceptibility. Automated conversational agents (ie, chatbots) are being developed for cancer genetics contexts; however, randomized comparisons with standard of care (SOC) are needed. To examine whether chatbot and SOC approaches are equivalent in completion of pretest cancer genetic services and genetic testing. This equivalence trial (Broadening the Reach, Impact, and Delivery of Genetic Services [BRIDGE] randomized clinical trial) was conducted between August 15, 2020, and August 31, 2023, at 2 US health care systems (University of Utah Health and NYU Langone Health). Participants were aged 25 to 60 years, had had a primary care visit in the previous 3 years, were eligible for cancer genetic evaluation, were English or Spanish speaking, had no prior cancer diagnosis other than nonmelanoma skin cancer, had no prior cancer genetic counseling or testing, and had an electronic patient portal account. Participants were randomized 1:1 at the patient level to the study groups at each site. In the chatbot intervention group, patients were invited in a patient portal outreach message to complete a pretest genetics education chat. In the enhanced SOC control group, patients were invited to complete an SOC pretest appointment with a certified genetic counselor. Primary outcomes were completion of pretest cancer genetic services (ie, pretest genetics education chat or pretest genetic counseling appointment) and completion of genetic testing. Equivalence hypothesis testing was used to compare the study groups. This study included 3073 patients (1554 in the chatbot group and 1519 in the enhanced SOC control group). Their mean (SD) age at outreach was 43.8 (9.9) years, and most (2233 of 3063 [72.9%]) were women. A total of 204 patients (7.3%) were Black, 317 (11.4%) were Latinx, and 2094 (75.0%) were White. The estimated percentage point difference for completion of pretest cancer genetic services between groups was 2.0 (95% CI, -1.1 to 5.0). The estimated percentage point difference for completion of genetic testing was -1.3 (95% CI, -3.7 to 1.1). Analyses suggested equivalence in the primary outcomes. The findings of the BRIDGE equivalence trial support the use of chatbot approaches to offer cancer genetic services. Chatbot tools can be a key component of sustainable and scalable population health management strategies to enhance access to cancer genetic services. ClinicalTrials.gov Identifier: NCT03985852.

Characteristics of and Factors Associated With Partner Service Uptake Cascade Among People With Newly Reported HIV/AIDS Diagnoses in Southeastern China in 2022: Cross-Sectional Survey.

HIV notification and testing integrated into partner service (PS) practices among HIV-positive individuals have been proven to be an efficient approach for case finding, although it remains a weak link in China. Although nonmarital sexual activities accounted for a large proportion of newly diagnosed HIV-positive cases in China, little is known about PS uptake and associated factors within nonmarital partnerships. This study aimed to describe HIV PS utilization and its associated factors among HIV-positive individuals with nonmarital sexual partners. We recruited newly diagnosed HIV-positive individuals who had nonmarital sexual partners in 2022 in Zhejiang Province and offered them PS. We described the PS uptake cascade within sexual partner categories and analyzed the associated factors with 3 primary outcomes from the participants' perspective: nonmarital partner enumeration, HIV testing, and HIV positivity. In this study, 3509 HIV-positive individuals were recruited as participants, and they enumerated 2507 nonmarital sex partners (2507/14,556, 17.2% of all nonmarital sex partners) with contact information. Among these, 43.1% (1090/2507) underwent an HIV test, with an HIV-positive rate of 28.3% (309/1090). Heterosexual commercial partners were the least likely of being enumerated (441/4292, 10.3%) and had the highest HIV-positive rate (40/107, 37.4%). At the participant level, 48.1% (1688/3509) of the participants enumerated at least one nonmarital sex partner with contact information, 52.7% (890/1688) had a sex partner tested for HIV, and 31% (276/890) had at least one nonmarital sex partner who tested positive. Multivariate analysis indicated that gender and transmission route were associated with both nonmarital sex partner enumeration and HIV testing. Age and occupation were associated with nonmarital sex partner enumeration and HIV positivity. Compared with participants who had no regular nonmarital sex partner, those who had a regular nonmarital sex partner were more likely to enumerate nonmarital sex partners (adjusted odds ratio [aOR] 3.017, 95% CI 2.560-3.554), have them get tested for HIV (aOR 1.725, 95% CI 1.403-2.122), and have an HIV-positive nonmarital sex partner (aOR 1.962, 95% CI 1.454-2.647). The percentage of partner enumeration was low, and HIV testing rate was moderate among nonmarital partnerships of HIV-positive individuals. More efforts should be made to improve PS practices among HIV-positive individuals and address the gap in partner enumeration, especially for heterosexual commercial nonmarital partnerships. Additionally, enhancing PS operational skills among health care personnel could increase the overall efficiency of PS uptake in China.

Wealth disparities in maternal health service utilization among women of reproductive age in Ethiopia: findings from the mini-EDHS 2019

BackgroundEthiopia has made strides in reducing maternal mortality, but significant discrepancies in maternal health service utilization exist across socioeconomic levels. According to studies, women from higher-income households are far more likely to use essential services such as antenatal care, delivery care, and postnatal care than poorer women. This wealth disparity is a primary contributor to persistently high maternal mortality, particularly among poor populations. The study’s goal was to assess wealth disparities in maternal health service uptake and identify contributing factors.Methods and materialsWe used the Ethiopian Mini Demographic Health Survey (EMDHS), conducted in 2019 on women aged 15–49 living in selected census areas, with a weighted sample size of 3,909. The Erreygers Concentration Index (ECI) was used to measure wealth inequalities in maternal health care, and the ECI decomposition was used to identify factors contributing to inequality in maternal health services.ResultsMaternal health service utilization was pro-rich among women in Ethiopia. The prevalence of antenatal care service (ANC), delivery, and postnatal care (PNC) service utilization showed a pro-rich distribution among Ethiopian women, with ECI = 0.115 (95% CI: 0.091–0.137), ECI = 0.223 (95% CI: 0.191–0.276), and ECI = 0.121 (95% CI: 0.041-0.200), respectively. The ECI indices were decomposed to examine the contributing factors to disparities in maternal service utilization in Ethiopia. Mother’s current age, household family size, region, birth order, and parity were contributors to maternal health service utilization.ConclusionThe ANC service, delivery service and PNC service utilization showed a pro-rich distribution among Ethiopian women. Mother’s current age, household family size, region, birth order, and parity are important contributors of maternal health service inequality. To improve access and usage among low-income women, policymakers can develop programs including increasing the number of free or subsidized services and providing transportation.

Oncology Healthcare Professionals’ Awareness and Uptake of the Employee Assistance Programme in Three Public Healthcare Facilities in KwaZulu-Natal, South Africa

Institutional psychosocial support services have gained traction, globally, more so within the context of healthcare facilities. This is mainly due to the recognition that institutional psychosocial support services are beneficial to both employees and employers, alike. However, while these institutional psychosocial support services are important, their uptake remains relatively low. With the focus being on the employee assistance programme (EAP), this study aimed to explore the awareness and uptake of institutional psychosocial support services among oncology healthcare professionals (OHPs) in public healthcare facilities in KwaZulu-Natal (KZN), South Africa. Using the interpretative phenomenological approach, the qualitative study was conducted in three public healthcare facilities that offer oncology services in KZN. Semi-structured in-depth interviews were conducted among 31 participants who were OHPs in the three public healthcare facilities. Thematic data analysis produced two main themes and six respective sub-themes. The main themes were awareness of institutional psychosocial support services and low uptake of institutional psychosocial support services, mainly owing to adequate personal support systems, privacy and confidentiality concerns, and stigma. The study findings point to the need for stronger EAPs that are needs-based, promoted regularly, and evaluated, in public healthcare facilities. To encourage service uptake and address privacy, confidentiality and stigma concerns, innovative and non-stigmatising ways of promoting these services are required, including hybrid approaches to the provision of EAP services. The study findings can provide a valuable contribution to the continued development and strengthening of institutional psychosocial support services in public healthcare facilities.

Uptake of telehealth services by people recovering from road trauma in Victoria, Australia

Introduction In recent years, injury insurers in Australia have introduced compensation cover for services delivered via telehealth. The aim of this study was to investigate the uptake of telehealth services by people recovering from road trauma in Victoria, Australia, and the characteristics of participants accessing these services. Methods All Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry cases, aged ≥16 years, who sustained transport-related injury from March to August 2020, and were linked with the Transport Accident Commission claims dataset, were included in this registry-based cohort study. The primary outcome was the uptake of services accessed in-person and via telehealth. Results Within 12 months of injury, 413 participants accessed 93,035 services, with 1432 of these via telehealth (1.5%). Seventy-five percent of family counselling, 26% of psychology and 7% of medical consultations were accessed via telehealth. For telehealth users, a greater proportion had worked/studied prior to injury, met major trauma criteria, and were discharged to inpatient rehabilitation, compared to non-users. For participants with no telehealth use, a greater proportion were discharged home, and were classified as ‘rapid recovery’ clients. Conclusions While telehealth uptake was low during the study period, it was accessed by people with more severe injuries. There was also greater telehealth uptake during some of Victoria's strictest COVID-19 lockdowns. Telehealth may continue to be an appealing option for medical and psychological services into the future, and may assist with return to work following transport injury.

Newborn community health advancements among Ethiopian Orthodox Christian women in North Gondar, Ethiopia: community-based randomised trial protocol

IntroductionDespite significant progress over past decades, neonatal and infant morbidity and mortality remain unacceptably high in Ethiopia. Simple interventions have been shown to improve the health of children and reduce...

158 Evaluation of a multi-modal rehabilitation programme for people affected by cancer: the Active Together service

Abstract Purpose Rehabilitation (including prehabilitation) can help cancer patients prepare for and recover well from treatment, improve physical and psychological outcomes, and reduce demand on healthcare resources. Project description Active Together is a novel evidence-based multi-modal rehabilitation service for patients with cancer before, during and after their treatment. It was developed collaboratively by Sheffield Hallam University’s Advanced Wellbeing Research Centre (AWRC) and Sheffield Teaching Hospitals NHS Trust and funded by Yorkshire Cancer Research charity. The service is personalised to individual needs and includes exercise, nutrition, and psychological support. The service is delivered by a clinical team combining physiotherapists, exercise specialists, dietitians, and clinical psychologists at the AWRC and two community health and exercise facilities, with plans to extend to more sites as the service expands. Since launching in 2022, over 600 patients with either lung, colorectal, or upper gastrointestinal cancer have received support from the Active Together service. The evaluation of the service examines physical and psychological outcomes, alongside healthcare resource use. Service uptake and attrition rates will be examined by demographics such as age, gender, and ethnicity. The evaluation is due be completed in August 2024; therefore, the results will be available for this presentation. Conclusions The evaluation of this service will assess the feasibility and effectiveness of the Active Together Service in improving the lives of cancer patients, and addressing the health inequalities and barriers which may prevent someone from accessing the Active Together service. If the evaluation produces positive outcomes, it will support the case for embedding multimodal rehabilitation services within routine cancer care. Funding The Active Together service is funded by Yorkshire Cancer Research.

A Mixed Method Investigation of Parent-Adolescent Communication About Mental Health

PurposeParent-adolescent communication is critical for parents' recognition of a need for mental health treatment in their adolescent children. This study aimed to explore facilitators and barriers to parent-adolescent communication about mental health in order to generate ideas for interventions that improve communication and increase adolescent uptake of mental health services. MethodsTwenty adolescents aged 12 to 19 with a history of depression and/or anxiety were enrolled alongside one parent/guardian. Participants completed an online survey, followed by separate, semistructured interviews. Survey data were analyzed via paired and two-sample t tests. Separate, data-driven codebooks were developed from interview transcripts. Qualitative data were analyzed via a template analysis approach. ResultsAdolescents reported higher barriers to psychological help-seeking (24.0 + 7.3) when compared to parents (18.6 + 4.7), both on average (p = .008) and between individual dyads (p = .003). Parents reported better communication with their child (79.0 + 11.5), than adolescents did with their parents on average (68.7 + 17.3, p = .04). Fear of burdening parents, parental guilt and fear of parents' dismissal of mental health concerns were described as barriers to communication. Facilitators of communication included disclosure of familial mental health history, open-mindedness, and patience. Psychotherapy was described as positively impacting communication by assisting adolescents in understanding parents' perspectives, and teaching communication strategies. DiscussionBrief clinical interventions addressing structural and emotional barriers to psychological help-seeking, depression literacy, stigma and self-blame among parents, and disclosure of familial mental health history may encourage parent-adolescent communication and increase adolescents' access to mental health care.