Service Users Research Articles

Barriers and enablers to a coordinated MHPSS response in Lebanon: A case study of the MHPSS Taskforce

During humanitarian crises, under-resourced and overstretched health systems may not be able to fully meet mental health and psychosocial support (MHPSS) needs of affected populations, including refugees, internally displaced persons and host communities. Health system governance is vital to humanitarian health response, but there has been little research on this, particularly for MHPSS. We present a case study of a national MHPSS coordination mechanism (the MHPSS Taskforce) in Lebanon, a country which has experienced multiple crises and hosts over 2 million refugees. The aim was to explore the barriers and enablers facing the MHPSS Taskforce in responding to the needs of displaced and host populations in Lebanon. Interviews were conducted with 34 key stakeholders, including Taskforce members, representatives from non-governmental organisations, United Nations agencies, and government Ministries. Our findings show that the positioning of MHPSS within the humanitarian cluster system acts as a barrier to mounting an effective response, with the MHPSS Taskforce sometimes siloed rather than integrated across clusters. Coordination within the Taskforce was reported to be effective in some respects, but limited by a lack of clarity about its decision-making processes, affiliation, mandate, and inclusion of regional perspectives and key groups such as mental health services users in Lebanon. While the technical capacity of the Taskforce is strong, limited funding and staffing were seen to impact its capacity to effectively oversee the MHPSS response in Lebanon. Key recommendations include: the need for stronger mechanisms and operating procedures for interagency and inter-sectoral collaboration on MHPSS within the humanitarian cluster system; greater clarity on the role of the Taskforce and key Taskforce actors, streamlined reporting channels and greater inclusion of diverse perspectives, particularly mental health service users; and greater financial and human resources within coordination mechanisms to support the national MHPSS response in Lebanon.

Utilisation of maternal healthcare services and influencing factors in public health facilities in Addis Ababa, Ethiopia

Background: Ethiopian maternal mortality remains high, despite the implementation of extensive health programmes. This indicates that the full potential of maternal health services is not being effectively utilised.Aim: This study aimed to evaluate the utilisation and factors influencing maternal healthcare services in public health facilities in Addis Ababa.Setting: This study was conducted in five public hospitals and 10 public health centres of Addis Ababa city administration from 31st August 2023 to 13th October 2023.Methods: The study’s design utilised a cross-sectional quantitative technique, which involved interviewing 354 women from each group who received visits throughout their pregnancy, delivery and postpartum period. The data were analysed using SPSS version 26.Results: This study analysed maternal health service utilisation indicators, revealing a 70.8% overall utilisation of services, with antenatal care (ANC) at 85.5%, delivery at 71.58% and family planning services (PNC) at 55.4%. The study found that the length of time spent travelling to public health facilities significantly impacts the use of maternal health services. Pregnant women who travelled less than 30 min used services 2.29 times more than those over 2 h. The average client wait time also influenced service usage. Pregnant women with four or more prenatal care visits were more likely to use services.Conclusion: The study conducted in Addis Ababa’s capital city revealed that the utilisation of maternity health care services is not optimal, despite the concentrated resources.Contribution: The findings of the study could be beneficial for the Addis Ababa Health Bureau, Ministry of Health, legislators, and other stakeholders. It can help in the development of affordable intervention programmes, filling knowledge gaps and updating scientific understanding.

Breaking the Silence: Addressing Domestic Abuse in Mental Health Settings-Identification, Screening, and Responding.

Individuals experiencing domestic abuse (DA) struggle to disclose victimization, but as frequent users of mental health services, this is a pivotal setting for identification and addressing DA. This systematic review of 20 studies investigates DA identification, screening, and responses within mental health settings. Three databases were searched using these inclusion criteria: adults aged 18 and older accessing mental health services, samples comprising mental health professionals (or combination). No geographical restrictions were applied. All studies were peer-reviewed and published in English between January 2000 and December 2023. Studies had to incorporate screening for DA between (ex-)partners and/or response to disclosure within mental health settings. The findings revealed considerable variation in DA screening methods from direct screening tools to retrospective analyses of patient files. Professionals report barriers in identifying DA, including uncertainty about their role, time constraints, and the importance of building trust with service users. Nonetheless, many highlight the importance of routinely asking about DA. A small number of interventions have been effective in enhancing professionals' readiness to address DA, but it remains unclear what format of training is most effective. Service users report feelings of shame and fear of not being believed when disclosing DA, but are aided by therapeutic engagement and enhanced professional awareness. There is a lack of diverse inclusion in the research. In summary, there is considerable scope to develop good practice to support mental health professionals' ability to identify and respond to DA across assessment tool and training, but also in understanding what facilitates service users to disclose.

Development and validation of an instrument to evaluate the perspective of using the electronic health record in a hospital setting

BackgroundEvaluating healthcare information systems, such as the Electronic Health Records (EHR), is both challenging and essential, especially in resource-limited countries. This study aims to psychometrically develop and validate an instrument (questionnaire) to assess the factors influencing the successful adoption of the EHR system by healthcare professionals in Moroccan university hospitals.MethodsThe questionnaire validation process occurred in two main stages. Initially, data collected from a pilot sample of 164 participants underwent analysis using exploratory factor analysis (EFA) to evaluate the validity and reliability of the retained factor structure. Subsequently, the validity of the overall measurement model was confirmed using confirmatory factor analysis (CFA) in a sample of 368 healthcare professionals.ResultsThe structure of the modified HOT-fit model, comprising seven constructs (System Quality, Information Quality, Information technology Service Quality, User Satisfaction, Organization, Environment, and Clinical Performance), was confirmed through confirmatory factor analysis. Absolute, incremental, and parsimonious fit indices all indicated an appropriate level of acceptability, affirming the robustness of the measurement model. Additionally, the instrument demonstrated adequate reliability and convergent validity, with composite reliability values ranging from 0.75 to 0.89 and average variance extracted (AVE) values ranging from 0.51 to 0.63. Furthermore, the square roots of AVE values exceeded the correlations between different pairs of constructs, and the heterotrait-monotrait ratio of correlations (HTMT) was below 0.85, confirming suitable discriminant validity.ConclusionsThe resulting instrument, due to its rigorous development and validation process, can serve as a reliable and valid tool for assessing the success of information technologies in similar contexts.

‘It provided me with a sense of safety that I hadn’t felt in weeks.’ A qualitative case study of service users’ experiences with sensory rooms in psychiatric inpatient units

Introduction Sensory rooms are environments designed to provide sensory input to help service users regulate arousal and manage distress. Sensory rooms are widely implemented in psychiatric inpatient units, but limited knowledge exists on how the sensory rooms are perceived by those who use them. This study investigated service users’ experiences with sensory rooms during admission. Methods A qualitative case study using semi-structured interviews conducted with 20 participants, admitted in acute, intensive, and open inpatient psychiatric units in Copenhagen, Denmark. Participants used the sensory rooms under guidance from occupational therapists or physiotherapists and were subsequently interviewed about their experiences. Interviews were transcribed and subjected to thematic analysis. Results Participants reported that being in the sensory rooms helped them to reconnect to their body and to experience peace of mind. Over time, participants used the sensory approaches to develop self-management strategies and enable participation in activities. Conclusion This study concludes that most of the participants had a positive experience in the sensory room under guidance from one of the unit’s physio or occupational therapists. Participants experienced increased physical and mental calmness in the sensory room and an increased sense of safety which made a difference during their admission and, for several of them, also in terms of their expectations for everyday life following their discharge.

Validity of the multidimensional reputation perception scale in private universities

University reputation is the result of the assessments that the stakeholders make of the university, especially the user of the education service, the student. The literature has shown an important impact of reputation on the student’s perception of the university, and it has been related to success, competitiveness, sustainability, stakeholder decision-making and the differential of the value offer. Therefore, its evaluation has been the subject of several studies that seek to measure and assess reputation in higher education to understand how to manage it. This article evaluates the psychometric properties of the reputation scale in students at private universities in Colombia. The methodology used included an adaptation of the scale to the Spanish language, content validity analysis, reliability analysis, exploratory factor analysis and confirmatory factor analysis. The results showed the validity and reliability of the scale and, through the analyses carried out, provided evidence of the scale’s robustness.

Employment and retirement among workers who develop vision loss in midlife.

Vision loss increases with age and is thus more likely to happen later in one's career. With more individuals working beyond typical retirement age, the possibility of experiencing vision loss while working has increased. The purpose of this study was to investigate how developing vision loss during midlife affects employment and retirement. Using longitudinal Health and Retirement Study data, we identified a sample of 167 workers, 44 to 64 years old, who developed vision loss and a matched comparison sample of 800 workers who did not. We explored job retention and retirement differences between the groups and differences between people with vision loss who retained jobs versus those who did not. Vision loss was associated with leaving the labor force, although there was a clear trend over time of increasing likelihood of job retention. Occupational category was associated with job retention and people who continued working had more favorable financial situations. Retirees with vision loss were more likely to report involuntary retirement and dissatisfaction with retirement. The decreasing likelihood of leaving the labor market after vision loss is an encouraging finding of this study. Workers who left the labor force after vision loss were more likely to be in precarious financial positions, and retirees did not have positive experiences with retirement. Assisting workers with vision loss to remain in the labor force is of vital importance, and increasing awareness and usage of free services for this population may reduce involuntary retirement and its negative consequences.

Internet Service Provision in Tanzania: An Examination of User Satisfaction, Package Pricing, and Service Challenges

This study examines the dynamics connected to the provision of internet service in Tanzania. Specifically, the study seeks to systematically analyse user perceptions service quality across different ISPs and identify the factors influencing their preferences and choice of ISPs. Two theoretical models, the Service Quality Theory (SERVQUAL) and the Expectancy Disconfirmation Theory (EDT) were applied to guide the study. A qualitative single case study design was used, with more than 800 user-generated comments extracted from a celebrity’s Instagram post. Data were analysed using sentiment analysis, qualitative and quantitative techniques. Our results show that while users acknowledge improvements in reliability of network, still inconsistencies remain, particularly in specific zones of Dar es Salaam and rural areas. T-CONNECT is perceived as having the most reliable network compared to other ISPs. Speed consistency remains a critical issue for all ISPs, with T-CONNECT seen as the most stable, whereas SKT-TZ and TZ-NET struggle, especially during peak hours. SKY-TZ, TZ-NET and TZ-LINK face coverage challenges, especially in rural areas due to infrastructure constraints. Moreover, the study highlights a high demand for reliable service, a push for fiber-optic infrastructure, and a cautious but optimistic outlook on 5G. Generally, the findings reveal that customers’ perceptions of internet service quality are influenced by network quality, and customer service and technical support. Challenges such as connectivity and network issues, pricing transparency and service plans, and customer support significantly affect user satisfaction and ISPs competitiveness. The contribution of this paper stems from its use of advanced NLP methods to examine user sentiments toward Tanzania’s ISPs from Instagram data, to provide insights and comprehensive understanding to industry practitioners and policymakers in promoting a more sustainable future for the industry.

Jewellery Making, Boundary Objects and Creativity in Social Work

The use of the arts in social work is creating space to reimagine effective communication, meaningful relationships and social change. Peripheral to this growing body of knowledge is jewellery design and making, a lacuna that this paper addresses within the context of recovery journeys. The paper presents art as an activity which can lead to tangible outputs, understood as ‘boundary objects’ and as an embodied aesthetic and sensory experience, for building dialogical relationships. Using the concept of ‘boundary objects’ is a new, yet achievable ambition for social work. Insights are presented from a small qualitative study on the use of jewellery making for assisting women, who have experienced trauma, to develop a positive self-identity and confidence. Jewellery making is introduced as a method for reframing trauma narratives into tangible objects. Part of the women’s embodied experiences are situated in the jewellery, an object of adornment external to them, rather than remaining trapped inside their body. For social workers, identifying objects (a piece of jewellery, a photograph, or any range of items) that symbolises or contains meaning for service users, can unlock a conversation that can lead to a deeper understanding of the person, their past, present and future ambitions.

Personal Identity Proofing for E-Commerce: A Case Study of Online Service Users in the Republic of Korea

The rapid expansion of non-face-to-face e-commerce services in the Korea has significantly increased the importance of personal identity proofing (PIP) for verifying users in online transactions, such as payments, refunds, membership registrations, and access to age-restricted products. Currently, personal identity proofing agencies (PIPAs) indiscriminately provide all of a user’s personal information to internet service providers (ISPs), leading to substantial privacy concerns and preventing users from selectively disclosing only the necessary information. The objective of this paper is to enhance the safety, convenience, and security of PIP services by proposing a method that empowers users to control the personal information they disclose while enabling digital identity integration for both online and offline applications. To achieve this, an extensive overview and analysis of the current PIP systems in Korea is presented, including methods. The strengths and weaknesses of these systems are critically examined, revealing limitations in privacy protection, user convenience, and security. Based on this analysis, a new method is proposed that introduces differentiated levels of PIP means according to authentication strength, allowing for the minimal necessary disclosure of personal information. The proposed method aims to improve the stability and reliability of the PIP service environment by addressing current privacy concerns and enhancing user control over personal information. This approach can be applied to e-commerce services in Korea and other countries facing similar challenges, contributing to the development of safer and more reliable online services.

Ecotherapy for Adolescents Experiencing Mental Health Challenges: Qualitative Exploration of Perspectives of Adolescents and Parents

ABSTRACT Different forms of eco-therapeutic interventions have positively impacted the physical, psychological and social wellbeing status of service users across a range of age groups. However, there has been little evidence exploring the experience and perceived impact of an ecotherapy program for adolescents in the UK. This study explored perceptions of adolescents and their parents of an ecotherapy program targeting improved mental health and wellbeing. This study involved semi-structured interviews with adolescents and their parents. Interviews took place shortly after the program ended (adolescents and parents) and six weeks after (adolescents only). Interviews from the two groups were initially analyzed separately before being triangulated. Eight adolescents and seven parents were interviewed in total. Three themes were generated: building connections, learning and exposure, and comparing and constructing with prior services accessed. Perceived improvements across adolescents included reduced negative emotions and anxiety, and greater self-esteem, confidence, and social skills. For the latter theme, there were reported distinctive experiences of attending this ecotherapy program compared with professional mental health support services. Exploring nature brought adolescents together with benefits of engaging in support services that varied from the norm. Future research should examine the feasibility of using ecotherapy as an alternative treatment to traditional therapy in supporting mental health, and evaluate the economic viability of such a program for non-clinical support provision.

Living less safely through the pandemic in England for people with serious mental and physical health conditions: qualitative interviews with service users and carers of Black African, Caribbean, and South-Asian descent.

COVID-19 Ethnic Inequalities in Mental health and Multimorbidities (COVEIMM) is a mixed methods study to explore whether COVID-19 exacerbated ethnic health inequalities in adults with serious mental and physical health conditions. We analysed data from electronic health records for England and conducted interviews in Birmingham and Solihull, Manchester, and South London. Sites were selected because they were pilot sites for the Patient and Carer Race Equality Framework being introduced by NHS England to tackle race inequalities in mental health. Prior to the pandemic people in England with severe mental illnesses (SMIs) faced an 11-17-year reduction in life expectancy, mostly due to preventable, long-term, physical health conditions. During the pandemic there was a marked increase in deaths of those living with an SMI. This qualitative interview study aimed to understand the reasons underlying ethnic inequalities in mortality and service use during the COVID-19 pandemic for adult service users and carers of Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds living with serious multiple long-term mental and physical health conditions. We took a participatory action research approach and qualitative interviews undertaken by experts-by-experience and university researchers Participants were purposively sampled by ethnicity, diagnoses, and comorbidities across three geographically distinct sites in England. Transcriptions were coded inductively and deductively and analysed thematically. Findings indicated multiple points along primary and secondary health pathways for mental and physical health that have the potential to exacerbate the unjust gap in mortality that exists for Black and Asian people with SMIs. Issues such as timely access to care (face-to-face and remote), being treated in a culturally appropriate manner with empathy, dignity and respect, and being able to use services without experiencing undue force, racism or other forms of intersectional discrimination were important themes arising from interviews. These poor experiences create systemic and enduring healthcare harms for racialised groups with SMIs that need to be addressed. Our findings suggest a need to address these, not only in mental health providers, but across the whole health and care system and a need to ensure more equitable healthcare partnerships with service users, carers, and communities from racialised backgrounds who are often excluded.

Unpacking the care-related quality of life effect of England's publicly funded adult social care. A panel data analysis.

Adult Social Care (ASC) is the publicly-funded long-term care program in England that provides support with activities of daily living to people experiencing mental and/or physical challenges. Existing evidence suggests that ASC expenditure improves service users' care-related quality of life (CRQoL). However, less is known about the channels through which this effect exists and the effect on outcomes other than CRQoL. We fill this gap by analyzing survey data on ASC service users who received long-term support from 2014/15 to 2019/20 using panel data instrumental variable methods. We find that the beneficial impact of ASC expenditure on the CRQoL of both new and existing users is mostly driven by users aged 18-64 without any learning disability and users with no learning disability aged 65 or older receiving community-based ASC. Moreover, control over daily life, occupation, and social participation are the CRQoL domains that are improved the most. We also find that ASC expenditure has a beneficial effect on several other outcomes beyond CRQoL for both new and existing users including user satisfaction and experience, the ability to carry out activities of daily living independently, whether their home is designed around needs, accessibility to local places, general health, and mental health through reduced anxiety and depression. Greater ASC expenditure, however, does not address the need for other forms of support such as unpaid informal and privately-funded care.

Optimizing fleet, staff configuration and operational strategies in one-way mixed fleet carsharing systems: a Lagrangian relaxation-based approach

ABSTRACT This study explores enhancing carsharing services by integrating gasoline and electric vehicles into a one-way mixed fleet carsharing system (OMFCS). The focus is on optimizing configurations (fleet and staff size, initial deployment) and operational strategies (vehicle relocation and staff rebalancing) while considering carbon emission costs. Employing a space-time-electricity network modeling approach, we developed an integer linear programming model to tackle the configurations and operational strategies optimization problem. For solving this model, we introduce a Lagrangian relaxation-branch bound approach, which integrates subgradient, dynamic programming and greedy-based heuristics algorithm. An illustrative case and a real-world case are conducted to demonstrate the efficiency of the proposed solution method and the analysis sheds light on the configurations and operational strategies of OMFCS. The sensitive analysis results suggest that OMFCS is more profitable and balances user service quality and carbon emissions better than carsharing systems using only one type of vehicle.

Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial.

Early neurodevelopmental risks, compounded with traumatic medical experiences, contribute to emotional and behavioral challenges in as many as 1 in 2 children with congenital heart disease (CHD). Parents report a strong need for supports; yet, there remains a lack of accessible, evidence-based behavioral interventions available for children with CHD and their families. I-InTERACT-North is a web-based stepped-care mental health program designed to support family well-being and reduce behavioral concerns through positive parenting for children with early medical complexity. In previous pilot studies, the program was effective in increasing positive parenting skills and decreasing child behavior problems, with high parent-reported acceptability. This paper presents the protocol for the first randomized study of stepped-care parent support for families of children with CHD. This study will involve a single-site, 2-arm, single-blind randomized controlled trial to evaluate (1) the feasibility and acceptability of a web-based stepped-care parent support program (I-InTERACT-North) and (2) the effectiveness of the program in enhancing positive parenting skills and reducing behavioral concerns among families of children with CHD. Families will be randomized (1:1) to either receive treatment or continue with care as usual for 12 months. Randomization will be stratified by child's sex assigned at birth and baseline parent-reported child behavior intensity. Primary outcomes include positive parenting skills and child behavior at baseline, 3 months, 6 months, and 12 months. Secondary outcomes include parental mental health, quality of life, service usage, and feasibility including program reach and adherence. A sample size of 244 families will provide >95% power to detect an effect size of d=0.64. Based on attrition data from pilot studies, a target of 382 families will be enrolled. Parent reports of acceptability, adoption, and suggested adaptability of the program will be examined using cross-case thematic analyses. Primary efficacy analysis will be conducted using an intent-to-treat approach. Generalized estimating equations will be used to examine changes in positive parenting. Child behavior, quality of life, and parent mental health will be tested with repeated-measures analyses. Additional sensitivity and replication analyses will also be carried out. Recruitment began in February 2024, and recruitment and follow-up will continue until January 2029. We anticipate results in late 2029. This study aims to test the effectiveness of I-InTERACT-North web-based stepped-care parent support in improving positive parenting skills and reducing child behavior problems in families of children with CHD compared with a care as usual control group. Results will inform future clinical implementation and expansion of this program among families of children with early medical conditions. ClinicalTrials.gov NCT06075251; https://clinicaltrials.gov/study/NCT06075251. DERR1-10.2196/64216.

Association of PCSK9 inhibitors with mortality: insights from a retrospective cohort analysis.

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are effective in reducing cardiovascular events, but their impact on all-cause mortality and medical utilization compared to statins is unclear. This study investigated PCSK9 inhibitor use and its impact on mortality and medical utilization vs. statins, using TriNetX database data with up to 9 years of follow-up. This retrospective cohort study analysed TriNetX data spanning 1 July 2015, to 31 December 2023, including 79194 PCSK9 inhibitor users (alirocumab, evolocumab, inclisiran) and 5437513 statin users with hyperlipidaemia. The primary outcomes were all-cause mortality and medical utilization, including hospital inpatient services, emergency department visits, critical care, and mechanical ventilation. Propensity score matching showed that PCSK9 inhibitor use was associated with a 28.3% lower risk of all-cause mortality [adjusted hazard ratio (aHR) 0.717, 95% confidence interval (CI): 0.673-0.763] and significant reductions in medical utilization (hospital inpatient services usage: aHR 0.692, 95% CI: 0.664-0.721; emergency department services: aHR 0.756, 95% CI: 0.726-0.788; critical care services: aHR 0.619, 95% CI: 0.578-0.664; and mechanical ventilation: aHR 0.537, 95% CI: 0.484-0.596) compared to statins. These findings were consistent across various demographics and clinical subgroups. The sensitivity analyses supported the robustness of the findings. PCSK9 inhibitors significantly reduced all-cause mortality and medical utilization compared to statins, suggesting their important role in dyslipidaemia management, particularly for statin-naïve or intolerant patients. Further research, including randomized controlled trials, is needed to confirm these findings and explore the underlying mechanisms.

Mobile Apps for Vaccination Services: Content Analysis and Quality Assessment.

Vaccination services are increasingly in demand by the public, and mobile apps are an effective tool to meet that demand. However, the characteristics and quality of these apps are unknown. Commonly used vaccination service apps on the market were surveyed with regard to quality, service content, and user experience to evaluate and guide users. The Qimai Data mobile app data analytics platform was used to search for common vaccination service apps by keyword, and the WeChat and Alipay platforms were searched for apps. The apps included in the study were independently evaluated by two reviewers using the Mobile Application Rating Scale, and the service content and user experience of the apps were analyzed. The intragroup correlation coefficient between raters was used to measure interrater reliability. In the app stores of the four major Android platforms and the iOS app store, 1092 and 207 apps were found, respectively; 189 WeChat applets and 30 Alipay applets were also found. A total of 29 apps was ultimately included in this study according to the inclusion criteria, including 21 independent apps, 4 WeChat applets, and 4 Alipay applets. Significant differences were found between independent apps and applets in terms of the quality score (t449.57=-5.301; P<.001) and the subjective quality score (z=-4.753; P<.001). No significant differences were found between iOS and Android platforms in terms of the quality score (t1404=-2.55; P=.80) and the subjective quality score (z=-0.137; P=.89). There was good intragroup consistency among the raters. In this study, independent apps and nonindependent apps that rely on social and payment platforms for implementation were included in the vaccination services category. The overall quality of these apps was acceptable. Nonindependent running apps were found to have slightly lower scores and showed room for improvement, and scores for the participatory apps were found to be generally low overall.

Guided Slow Looking for Young Psychiatric Service Users: A phenomenological approach to arts and mental health recovery

Guided Slow Looking for Young Psychiatric Service Users: A phenomenological approach to arts and mental health recovery

AMENDMENTS TO THE LAW ON FINANCIAL COMPANIES IN THE SPIRIT OF PROTECTING CITIZENS’ INTERESTS

Nonbank financial companies, also known as financial companies, are financial institutions that offer various financial services, such as: approving loans to individuals and legal entities, issuing and administering credit cards, factoring and issuing guarantees, as well as advising on various financial and leasing activities. Unlike banks, for the establishment of a financial company, a simpler procedure is foreseen, even a license from the National Bank is not required, but only permission from the Ministry of Finance. The establishment, operation and supervision of financial companies in the country is governed by the Law on Financial Companies. As institutions that are in their infancy in the country and given the still insignificant impact on the financial sector, it is expected that the legislator will often make changes and additions to the legal regulations for financial companies. The purpose of these changes in the legislation of financial companies is to provide an operating environment for them between the protection of the users of services from financial companies and the increase of reliability towards these companies. In this paper, the author, in addition to analyzing the legislative platform and the recent changes in this platform, but through the statistical method provides an overview of the activity of financial companies in the Republic of North Macedonia.

Exploring the determinants of online health service usage intentions under the threat of air pollution.

The rapid evolution of online health services (OHS) has significantly improved healthcare accessibility. However, the impact of air pollution on individuals' willingness to engage with OHS remains underexplored in the existing literature. This study addresses this gap by investigating how air pollution threats influence the intention to use OHS, grounded in Protection Motivation Theory (PMT) and Rational Choice Theory (RCT). Using cross-sectional survey data, a theoretical model was developed and tested to examine the relationships between threat appraisal, coping appraisal, perceived benefits, perceived costs, and OHS usage intentions. The findings indicate that threat appraisal, coping appraisal, and perceived benefits positively affect the intention to use OHS, while perceived costs negatively impact usage intention. Additionally, age significantly moderates the relationship between coping appraisal and the intention to use OHS. This study extends the application of PMT and RCT in the context of OHS. It provides valuable insights into the factors influencing users' intentions to utilize these services, with implications for improving OHS adoption in environments affected by air pollution.