Training Of Health Care Providers Research Articles

Prostate cancer screening in the Middle East and North Africa: a cross-sectional study on current practices.

Prostate cancer is a significant health concern in the Middle East and North Africa (MENA), with many cases diagnosed at advanced stages, a high mortality-to-incidence ratio, and low prostate cancer awareness. This study aims to evaluate prostate cancer screening practices in the region to inform effective early detection and management strategies. A cross-sectional survey was conducted from July 1, 2023, to November 8, 2024, among physicians from 19 countries in the MENA region. The study utilized a validated questionnaire to assess prostate cancer screening practices, barriers, and educational needs. The survey had a response rate of 96.8%, with 1,163 participants. Of these, 34.7% routinely performed prostate cancer screenings, with 61.1% using PSA tests. The primary barrier was lack of patient awareness (51.2%). Additionally, 65.3% of participants had no formal training. To improve screening rates, participants suggested better patient education (63.5%), increased training for healthcare providers (41.9%), and improved access to screening equipment (38.9%). This study reveals that prostate cancer screening was low, with barriers including a lack of patient awareness and formal training among physicians. Addressing these issues through culturally tailored education programs may improve early detection rates and ultimately reduce the burden of prostate cancer in the MENA region.

Retrospective review of assisted peritoneal dialysis: The Alberta, Canada experience.

Assisted peritoneal dialysis (PD), where trained health care providers assist individuals with PD in their home, allows individuals, who would otherwise be ineligible, to pursue home dialysis. Alberta Kidney Care South started an assisted PD program in 2011 using licensed practical nurses (LPNs) and switched to health care aids (HCA) July 2018. A retrospective chart review to describe characteristics of assisted PD patients and their outcomes for each of the models of health care. The primary outcome was the duration of assisted PD from initiation to exit. Secondary outcomes included reasons for exit and the proportion of patients who performed independent PD. A total of 135 patients received assisted PD, mean age 70.7 ± 11.2 years and 44.4% (60/135) women. The average time to exit from assisted PD was 366.2 ± 378.1 days. There was no difference between time in PD between LPN (1.89 [1.02, 3.85] years) and HCA (2.09 [0.89, 3.26] years), p = 0.98. Main reasons for exit from assisted PD included death 30.4% (41/135) and switching to hemodialysis 26.7% (36/135). Total of 29 patients (21.5%) continued PD independently for an additional 495 ± 399 days. There was no difference in reasons for exit, p = 0.90 or peritonitis rates between the two care models, p = 0.60. Assisted PD allows patients to maintain independence in the community and facilitates the uptake of independent PD in a significant proportion. Utilizing an HCA model offers a cost-effective alternative while still providing high-quality care.

Wee Nuzzle: A QI Initiative to Promote Nonnutritive Breastfeeding for Preterm Infants.

Nonnutritive breastfeeding (NNBF) benefits preterm infants younger than 34weeks' gestational age (GA), but it is often delayed in those on noninvasive respiratory support. Our primary aim was to reduce the mean number of days to NNBF by 50% in infants born at less than 34weeks' and more than 30weeks' corrected GA within a 12-month period. Our global aim was to increase provision of human milk at discharge. This 1-year quality improvement (QI) initiative involved a multidisciplinary team employing a key driver diagram, fishbone analysis, and "Wee Nuzzle" guidelines, implemented through Plan-Do-Study-Act cycles. The first cycle focused on training health care providers, the second on integrating NNBF into medical progress notes, and the third on incorporating NNBF into the electronic medical record (EMR). Data were collected using EMR and the California Perinatal Quality Care Collaborative database. The initiative achieved its Specific, Measurable, Achievable, Realistic and Time bound (SMART) aim, reducing the mean time to first NNBF by 66%, from 12.0 to 4.1days. Additionally, the global aim of increasing human milk provision at discharge improved from 59% to 72%. This QI initiative effectively reduced the time to first NNBF attempt and increased human milk provision at discharge. Ongoing assessment of human milk exposure post-neonatal intensive care unit discharge is needed.

Manifestation of Chronic and Non-Communicable Diseases Among Filipino Internationally Educated Nurses in Finland: A Qualitative Study.

Limited research has explored the impact of migration on the manifestation of noncommunicable diseases (NCDs) among internationally educated nurses (IENs) in Finland. This study aimed to describe Filipino IENs' experiences with the manifestation of NCDs among them. Secondary data from 10 IENs working in two hospitals were analyzed using Braun and Clarke's thematic analysis. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist. Three key themes emerged: insufficient knowledge and lack of interest in health promotion, migration as a factor, and occupational health challenges. Migration was found to impact NCD occurrence. Inadequate knowledge and underutilization of occupational health services were identified as a barrier to prevent the risk of getting NCDs. Long waiting periods for appointments and language barriers exacerbated these risks. Limited awareness of available occupational health services and disinterest in health promotion contributed to NCD manifestation among IENs. Lengthy waiting times highlighted the need for educational campaigns on health-promoting activities. Cultural competence training for local healthcare providers can improve culturally sensitive occupational healthcare for IENs. Health promotion education should be provided to IENs before their migration. Upon arrival, nurse managers should inform the nurses about the availability of occupational healthcare services provided by the employer, ensuring easy access. Additionally, efforts should be made to ensure that nurses integrate well into society, including facilitating access to recreational activities.

Association of experienced stigma in healthcare settings with health outcomes among Black women living with HIV: Mediating roles of internalized stigma, anticipated stigma, and trust in HIV care.

Black women living with HIV (WLHIV) often have suboptimal ART adherence due to a multitude of social and structural barriers, including HIV-related stigma. Trust in healthcare providers plays a significant role in adhering to ART and is likely lower among Black WLHIV compared to their White counterparts. This study examined the relationship between experienced stigma in healthcare settings and ART adherence and viral suppression through anticipated stigma in healthcare settings, internalized stigma, and medical mistrust. Participants included Black WLHIV from the Women's Interagency HIV Study (WIHS). We conducted serial mediation analyses where experienced HIV stigma in healthcare settings is associated with higher anticipated or internalized HIV stigma, leading to higher mistrust in HIV care providers, and ultimately, to lower ART adherence and viral suppression, adjusting for demographic and clinical covariates. Of the 1,060 WLHIV, approximately 84% achieved optimal ART adherence, and 65% had an undetectable viral load. Serial mediation analyses suggested significant indirect associations between experienced stigma in healthcare settings and ART adherence or viral suppression. Specifically, experienced stigma was associated with higher anticipated or internalized stigma, which was associated with mistrust in HIV care providers, resulting in lower ART adherence and reduced likelihood of undetectable viral load. Interventions could focus on training healthcare providers to address implicit biases and create supportive healthcare environments. Integrating mental health support to reduce internalized stigma and using community engagement and education to address anticipated stigma may further improve trust in providers, leading to better health behaviors and outcomes.

Aging and Gender: Inclusive Care Practices and Policies for Lesbian, Gay, Bisexual and Transgender Older Adults

In line with global population aging, the number of lesbian, gay, bisexual, and transgender (LGBT+) older adults is expected to continue to increase. Compared to their heterosexual peers, LGBT+ older adults have poorer physical and psychological health status, experience less social support, and face more barriers when accessing healthcare services, which may lead to higher health disparities and a lower quality of life within LGBT+ older populations. Healthcare providers have been shown to be inadequately prepared to address the unique healthcare needs and challenges of LGBT+ older adults, often leaving these individuals forced to receive care that does not meet their health needs and expectations. Based on the Declaration on Universal Health Coverage proposed by the United Nations and the World Health Organization, medical care and long-term care facilities must provide to healthcare providers training courses in culturally competent care and foster LGBT-friendly care environments to achieve health equity and universal health coverage for LGBT+ populations.

Barriers LGBTQ+ Individuals Face in Accessing Healthcare Services Including HIV Prevention and Treatment Due to Stigma and Discrimination in Lesotho

Background: Lesotho faces significant challenges in providing equitable healthcare services to LGBTQ+ individuals, particularly regarding HIV prevention and treatment. The country has one of the highest HIV prevalence rates globally, with marginalized populations, including LGBTQ+ individuals, experiencing heightened vulnerability due to systemic stigma and discrimination. Aim: The study assessed the barriers LGBTQ+ individuals face in accessing healthcare services including HIV prevention and treatment due to stigma and discrimination in Lesotho. Setting: The study was conducted in three districts of Lesotho which are Maseru, Leribe, and Mokhotlong. Methods: The study cross-sectional, descriptive, qualitative research study utilized semi-structured interviews with LGBTQ+ individuals and healthcare providers to explore the interplay between stigma, mental health, and HIV vulnerabilities. Results: The findings reveal a complex relationship between stigma and health outcomes, where social marginalization leads to increased HIV vulnerabilities among LGBTQ+ populations. Discriminatory attitudes within healthcare settings discourage individuals from seeking major HIV preventive services, ultimately impacting public health efforts to control the epidemic. Conclusion: Addressing the barriers faced by LGBTQ+ individuals in Lesotho requires a multifaceted approach such as training for healthcare providers on LGBTQ+ issues, and integrating sexual and reproductive health services into community outreach programs. By fostering an inclusive healthcare environment, can enhance access to HIV prevention and treatment services, improving overall public health outcomes in Lesotho. Contribution: The findings and recommendation of the study could contribute to a better health outcome for LGBTQ+ individuals in Lesotho.

Knowledge, Attitudes, and Practices of Healthcare Providers and Healthcare Experiences of Women Regarding Female Genital Mutilation/Cutting (FGM/C): A Scoping Review of Evidence from Canada and the United States.

Healthcare providers (HCPs) play a critical role in the care of women with experience of FGM/C although there is limited research on knowledge about FGM/C among HCPs in Canada and USA. Research evidence suggests that many women with experience of FGM/C have negative care experiences. We sought to investigate the knowledge, attitudes, and practices of Canadian and USA HCPs regarding FGM/C, along with women's healthcare experiences with FGM/C in both countries. We conducted a scoping review guided by Arksey & O'Malley's framework. We exported 4054 peer-reviewed records from Embase, Global Health PubMed, Medline, and Scopus databases. After screening titles, abstracts and full texts using inclusion criteria such as publication between 2000 and 2023, a focus on FGM/C and studies conducted in USA and Canada, we included 13 articles in the final review. Care provider studies revealed that HCPs reported a desire for more knowledge and training to enable them to provide high-quality care for women with FGM/C. Majority of the studies have revealed reliance of HCPs on informal learning channels to gain knowledge on FGM/C. Findings reveal that many women with experiences of FGM/C have reported insensitive comments from HCPs including some nurses' unsympathetic behavior toward FGM/C related postpartum discomfort. In some studies, majority of the women felt their doctors were unable to care for them while other women noted that shame and discomfort deterred them from further care seeking. HCPs play an important role in caring for FGM/C patients. Nonetheless HCPs often receive no training or training that is inadequate (insufficient to make providers feel confident to provide care) on how to provide high-quality, culturally competent care leading to poor experiences for women. This necessitates concerted efforts to provide high-quality training of HCPs for better care for women with FGM/C.

Shared decision-making between patients and healthcare providers at rural health facilities in Eastern Uganda: an exploratory qualitative study

BackgroundShared decision-making in healthcare is a collaborative process where patients are supported to make informed decisions according to their preferences. Healthcare decisions affect patients' lives which necessitates patients to participate in decisions concerning their health. This study explored experiences and ethical issues related to shared decision-making in a rural healthcare setting.MethodsAn exploratory qualitative study was conducted at Budumba Health Centre III and Butaleja Health Centre III in rural Eastern Uganda. In this study, 23 in-depth interviews were conducted among 12 healthcare providers and 11 patients. Data was analyzed thematically using NVivo-12 plus software.ResultsFour themes emerged which included: Paternalistic cultures of care, challenges, strategies for improvement, and ethical issues. Patients at both facilities expressed the need to be involved in decision-making processes. However, many stressed that they are not engaged in decision-making about their health. Many healthcare providers noted that shared decision-making could improve patient prognosis but are faced with challenges related to low male involvement and the influence of cultural and religious practices, including myths and patriarchal attitudes which impact effective patient engagement.Ethical issues identified include concerns about informed consent, privacy and confidentiality, deception, and harm.ConclusionsThis study highlighted the need for better sensitization of patients and comprehensive training for healthcare providers to minimize and resolve ethical issues that emerge during shared decision-making processes. Therefore, targeted interventions are needed to enhance decision-making processes in rural healthcare including but not limited to developing shared decision-making manual and continuous training of healthcare providers to ethically engage patients. Further research is needed to explore larger facilities with a bigger scope including patients under 18 years of age and and their surrogates.

Transforming Care Through Co-Design: Developing Inclusive Caregiver-Centered Education in Healthcare

Background: Family caregivers provide most (75–90%) of the essential unpaid care and support for individuals living with chronic conditions, disabilities, and age-related needs in the community, with about half performing medical tasks traditionally performed by professionals. Caregivers also assist with 15 to 35% of the care in congregate care settings. Yet despite their critical contributions to patient care, caregivers face stress, declining well-being, and insufficient recognition in healthcare systems. Addressing these challenges requires innovative, person-centered approaches to training healthcare providers. Co-design or co-production are participatory research methods that involve individuals with lived experience to ensure relevance and impact. Objective: This study sought to understand how participatory co-design principles influenced learning, collaboration, and engagement among diverse participants in developing a caregiver-centered education program for healthcare providers. Actionable recommendations for optimizing co-design processes are provided. Methods: Eighty-five participants from a team of 155 collaborators, including caregivers, healthcare providers, educators, policymakers, and leaders, participated in ten focus group sessions conducted in Zoom breakout rooms. Interviews were transcribed verbatim and analyzed using Thorne’s interpretive description and Braun and Clarke’s reflexive thematic analysis. Results: Participants described the co-design process as fostering collaboration, inclusivity, and skill enhancement. Exposure to diverse perspectives expanded transformative understanding and prompted reflection on caregiver support within professional practices. Skilled facilitation ensured equitable engagement. Challenges included information overload and personal time constraints. Participants liked using breakout rooms to mitigate the dynamics of large group management. Still, they recommended pre-meeting materials, flexible scheduling, and expanding stakeholder diversity (e.g., rural, Indigenous, and immigrant caregivers). Conclusions: Co-design fosters meaningful, caregiver-centered education through collaboration and inclusivity. Addressing logistical challenges and representation gaps can further enhance the impact of co-design and empower multi-level, interdisciplinary partners to inform equitable healthcare education.

Umbrella review on intimate partner violence against women towards understanding the relevance of data from observatories

This umbrella review synthesized data from systematic reviews and meta-analyses on intimate partner violence (IPV) against women, focusing on data collected through observatories in Latin America. The study examines the effects of IPV on health, social support networks, and mental health and evaluates how integrated data can guide prevention and intervention strategies. A literature search has conducted across PubMed/MEDLINE, BVS/LILACS, and Cochrane Databases for studies published between 2014 and 2024. Standardized indexing terms (MESH and DECS) were used to identify relevant systematic reviews and meta-analyses. Studies published in English, Spanish, and Portuguese with a focus on Latin America have been included. Two independent reviewers selected studies based on predefined criteria, with conflicts resolved by a third reviewer. Data extraction followed PRISMA 2020 guidelines, and 24 articles have been included in the final analysis. The findings show gaps in IPV prevention, including limited training for healthcare providers, ineffective intersectoral communication, and insufficient resources for victims. IPV consequences such as depression, PTSD, and physical injuries were identified, along with the roles of support networks, shelters, and public policies. Data from observatories demonstrated the capacity to integrate multisectoral information to improve prevention and intervention strategies. Addressing IPV requires a multidisciplinary and intersectoral approach, including training for healthcare providers, strengthening support services, and utilizing integrated data. Observatories contribute to public policy development and coordinated interventions to assist victims and reduce IPV prevalence.

The trend of suicide and self-harm in the Chinese population from 2018 to 2022 based on ambulance medical emergency cases: a retrospective study.

This study investigates the trends of suicide and self-harm in Nanjing, China, through 4 years of data collection, aiming to provide valuable information for developing effective suicide prevention strategies. This descriptive study analyzed Nanjing Emergency Medical Center (NEMC) ambulance records from Nanjing (2018-2022) to investigate suicide and self-harm events. Out of 689,305 records, 4,261 cases were included after exclusions. The study categorized incidents into 4,103 suicide events and 158 self-harm cases. Descriptive statistics and content analysis were conducted to identify characteristics and themes related to these events, with age groups defined according to American Medical Association standards. The study highlights drug poisoning as the leading method, accounting for 63.56% of the 4,103 suicide events. It notes significant trends by age, gender, and season, with males showing higher rates of self-harm. The study emphasizes the need for targeted prevention strategies, particularly focusing on drug-related suicides among adults and adolescents, as well as the prevalence of various self-harming behaviors. To reduce self-harm and suicide, interventions must be strengthened for women, who experience higher rates. Key strategies include regulating pesticides and psychotropic drugs, increasing access to mental health resources, and launching community awareness campaigns. Additionally, training healthcare providers and promoting family education can enhance support for women facing mental health challenges.

A perinatal psychiatry access program to address rural and medically underserved populations using telemedicine

BackgroundAlthough highly prevalent, most perinatal mental health and substance use disorders often go unrecognized, undiagnosed, and untreated. Perinatal Psychiatry Access Programs have emerged as a successful model to increase the capacity of front-line maternal health care providers to address perinatal mental health conditions through education, consultation, and increased resources and referrals.MethodsThis model has been adapted in South Carolina to include direct access to mental health treatment in response to inadequate maternity care and mental health services, including a large proportion of rural, Medically Underserved Areas in Primary Care and Mental Health Healthcare Provider Shortage Areas throughout the state. Moms IMPACTT [Improving Access to Perinatal Mental Health and Substance Use Disorder Care Through Telehealth and Tele-mentoring] leverages statewide partnerships and a virtual care model to provide: 1) people who are pregnant or within 1 year postpartum with immediate access by phone or internet to a clinician trained in perinatal psychiatric care coordination to assess and refer to an appropriate level of perinatal psychiatry services; 2) communication and care coordination with the person’s healthcare provider, as appropriate; and 3) healthcare provider training and real-time psychiatric consultation for the management and treatment of perinatal mental health and substance use disorders. Adaptations to this care model have demonstrated benefit including increase access to care for patients with perinatal mental health and substance use disorders and support for frontline health providers serving this population.ResultsWithin the first 12 months, the Mom’s IMPACTT program served people from 45 of the 46 counties in South Carolina. There were 938 encounters, 96% of which resulted in telehealth or teleconsultation with a care coordinator or program psychiatrist. Treatment was provided to 881 perinatal patients (54.6% White, 26.1% Black, 6.2% Hispanic) of whom 51.8% were insured by Medicaid, 89.7% resided in counties designed as fully Medically Underserved Areas, and 38.9% lived in counties designed as fully rural. Most calls were received directly from perinatal patients, with 60.7% (548/903) of patients requesting mental health support. Additionally, the program completed 22 consultations, and trainings with 443 healthcare providers throughout the state.ConclusionsAdaptations made to psychiatry access program evident in Moms IMPACTT appear to be successful in meeting the specific needs of birthing people in the state of South Carolina. Suggestions and considerations are included to replicate the success of Moms IMPACTT program elsewhere.

Pain Management Among Older Farsi and Azeri Speaking Immigrant Adults With Limited English Proficiency (LEP): Interpretive Approach.

Pain is a major public health issue in the United States. The ability to communicate the severity of pain with healthcare providers is crucial to receiving appropriate pain management. Many factors can limit this ability, including limited proficiency in the language spoken by providers. This body of research suggests gaps in the multidimensional approach to pain management for older adults with limited English proficiency (LEP). In this study, we describe the lived experiences of pain management of older adults with LEP living with chronic pain in the United States. We used a qualitative interpretive approach with semi-structured interviews from nineteen Farsi and Azeri-speaking older adults with LEP and chronic pain to describe the lived experiences of older adults with LEP. Participants relied on alternative medicine to manage their pain and reported fears of becoming dependent on prescription pain medications. Some reported poor physician-patient rapport and felt unseen by healthcare providers, and all reported language barriers even with the use of translators. Farsi and Azeri-speaking older adults with LEP and chronic pain felt the US healthcare system ignored their social, cultural, and linguistic needs. Pain management training for healthcare providers should address language barriers and include cultural competency.

Informational Sources About Breastfeeding Associated with Breastfeeding Initiation: Insights into Racial Disparities.

Background: Breastfeeding provides essential nutrition and disease protection for infants while reducing the risk of type 2 diabetes and breast cancer in mothers. Despite these benefits, significant racial and ethnic disparities exist in breastfeeding initiation, particularly among Black women. This study examines racial differences in the receipt of breastfeeding information from varying sources and their association with breastfeeding initiation. Methods: Data were obtained from the Phase 8 Core Pregnancy Risk Assessment Monitoring System for 2016-2020 (n = 163,724). The analysis focused on comparing the likelihood of breastfeeding initiation (yes/no) across racial groups and the impact of receiving breastfeeding information from varying clinical (mother's doctor/nurse/baby's doctor, etc.) and social sources (support group/family/friends, etc.). Univariate and multivariable analysis was conducted in SAS 9.4. Results: Black women consistently exhibited lower odds of breastfeeding initiation compared with other racial groups, across all informational sources. The study found that while information from both clinical and social sources increased breastfeeding initiation overall, Black women remained less likely to initiate breastfeeding than White women (p < 0.0001). Conclusion: Systemic barriers, including racism and bias in health care, contribute to the racial disparities in breastfeeding initiation. Culturally tailored interventions and improved health care provider training are necessary to address these gaps. Future efforts should aim to bridge the divide between clinical and social breastfeeding information sources to improve breastfeeding rates among minority women.

Overcoming Cultural Barriers to Managing Labor Pain Among Tanzanian Women Using Non-pharmacological Interventions.

Managing labor pain effectively is crucial for ensuring positive maternal health outcomes. In Tanzania, cultural barriers often hinder the acceptance and utilization of non-pharmacological pain management interventions. This clinical consultation explored strategies for overcoming these cultural barriers to improve labor pain management among Tanzanian women using non-pharmacological interventions. A comprehensive literature review of existing research on non-pharmacological pain management techniques and cultural influences on pain perception and management was conducted, and an observed case study regarding the need to utilize nonpharmacological pain management interventions was also added. Studies indicated that non-pharmacological interventions such as massage, breathing techniques, and relaxation methods are effective and can be culturally adapted to fit Tanzanian women's beliefs and practices. Key barriers to use using these interventions include lack of awareness, limited access to training for healthcare providers, and cultural stigmas associated with pain expression. Successful strategies to overcome these barriers involve community education, involvement of traditional birth attendants, training healthcare providers in cultural competence, and engaging community leaders and family members. Future research should further explore the cultural adaptation and effectiveness of these interventions to ensure their sustainable integration into maternal care practices in countries with limited resources.

Delay in treatment for childhood Acute Lymphoblastic Leukemia at the University of Gondar Comprehensive Specialized Hospital, Northwestern Ethiopia

Background: Despite the critical importance of early blood cancer diagnosis in children for timely treatment, late presentation, delayed diagnosis, and delayed treatment initiation remain significant issues in developing countries, including Ethiopia. Addressing these delays requires improving healthcare infrastructure, public awareness, provider training, and reducing financial barriers. This study aimed to assess referral delays, diagnostic delays, and overall treatment delays among children with acute lymphoblastic leukemia at the University of Gondar Comprehensive Specialized Hospital. Methods: A facility-based cross-sectional study was conducted among pediatric acute lymphoblastic leukemia (ALL) patients under 18 years. Data were collected using a structured questionnaire administered to primary caregivers from December 29, 2022, to January 30, 2024. During the study, 90 ALL cases were included using a consecutive sampling technique. Data were entered and analyzed using SPSS version 25 software, with results presented through descriptive statistics, including frequencies, percentages, graphs, and tables. Binary logistic regression examined associations between sociodemographic factors and treatment delays among childhood ALL patients. Results: A total of 90 children participated, 63 (70.0%) male. Median time from first symptoms to medical consultation was 9.7 days, referral delay 51.3 days, diagnosis delay 3.2 days, and treatment initiation delay 4.6 days. Total delay to treatment was 69 days, with induction mortality at 22%. High-risk ALL, malaria, and delays of 30–90 days increased induction mortality risk. Conclusion: The study revealed significant delays in childhood ALL treatment, contributing to high mortality rates. Timely diagnosis and treatment initiation are critical, particularly for high-risk patients and those with malaria. Strengthening healthcare infrastructure, awareness, and provider training is vital to improve outcomes.

Communication needs regarding heart failure trajectory and palliative care between patients and healthcare providers: A cross-sectional study.

Heart failure (HF) is a chronic condition with an unpredictable trajectory, making effective communication between patients and healthcare providers crucial for optimizing outcomes. This study aims to investigate and compare the communication needs regarding HF trajectory and palliative care between patients and healthcare providers and to identify factors associated with the communication needs of patients with HF. A cross-sectional study design was employed, involving 100 patients with HF and 35 healthcare providers. Data were collected using structured questionnaires assessing communication needs, health literacy, self-care behavior, and social support. Statistical analyses were performed, including Spearman's rank correlation, Pearson's correlation, and multiple regression analyses. Patients prioritized communication related to device-related questions, whereas healthcare providers focused more on aspects of HF in daily life. Both groups ranked end-of-life communication as the lowest priority. The communication needs of patients were positively correlated with health literacy (r = 0.27, p = .007), self-care behavior (r = 0.32, p = .001), and social support (r = 0.24, p = .016). Multiple regression analyses indicated that self-care behavior was a significant factor influencing the communication needs of patients (β = 0.27, p = .011). Enhanced patient-centered communication strategies are required to address the communication priority gaps between patients and healthcare providers. Improving health literacy, supporting self-care behaviors, and leveraging social support are critical in meeting patients' communication needs. Tailored communication training for healthcare providers can bridge this gap and improve overall HF management.

Urinary incontinence (UI) in older women in low- and middle-income countries: a rapid review and case study from Burkina Faso.

The prevalence of urinary incontinence (UI) in older women in low- and middle-income countries (LMICs) is not well understood. We conducted a rapid literature review to assess the burden of UI in this population and contextualize findings from a household survey of women aged 40 and older in Nouna, in northwestern Burkina Faso. The rapid review included 21 survey articles. UI prevalence for LMIC women 40 or older varied greatly (6%-80%), with differences by socio-demographics, gynecological factors (menopausal status, birth outcomes), comorbidities (age, education, obesity, diabetes, hypertension, arthritis), behaviors (smoking status) and survey location. The studies used validated tools-the International Consultation on Incontinence Urinary Incontinence Short Form (ICIQ UI-SF) was most common (n = 4, 19%)-and bespoke tools that have not yet been validated. In Nouna, 983 (64.5%) of 1,524 women, completed the ICIQ UI-SF. Overall UI prevalence, defined as reporting leakage at least 2-3 times a week, was 2.6% (95% CI 1.73%-3.85%), descriptively increased with age from 0.5% in 40-49 year-olds to 6.6% in those 70 and over. Of those with UI, 88.5% experienced leakage daily, and 50% reported moderate or greater interference with daily life, yet most (88.5%) had not spoken to a healthcare provider. Multivariable analysis revealed that UI was more common among women who were not currently married and decreased with higher education levels. Both the rapid review and survey highlight the burden of UI among older women in LMICs, particularly as they age beyond 60. Given UI's association with physical and mental health, it is crucial to raise awareness of its burden, improve healthcare access, and integrate routine screening into basic healthcare services. Additionally, training healthcare providers and developing culturally appropriate interventions will help address stigma and ensure effective management of UI in this vulnerable population.

Community Perspectives on Optimizing Community Health Volunteer Roles for HIV Prevention Services in Kenya and Uganda.

Community health workers (CHWs) play a significant role in supporting health services delivery in communities with few trained health care providers. There has been limited research on ways to optimize the role of CHWs in HIV prevention service delivery. This study explored CHWs' experiences with offering HIV prevention services [HIV testing and HIV pre- and post-exposure prophylaxis (PrEP and PEP)] during three pilot studies in rural communities in Kenya and Uganda, which aimed to increase biomedical HIV prevention coverage via a structured patient-centered HIV prevention delivery model. In-depth semi-structured interviews were conducted from November 2021 to March 2022 with CHWs (N = 8) and their clients (N = 18) in the Sustainable East Africa Research in Community Health (SEARCH) SAPPHIRE study. A seven-person multi-regional team coded and analyzed data using a thematic analysis approach. CHWs offered clients PrEP and PEP refills, adherence monitoring, counseling on medications, and phone consultations. Clients reported CHWs maintained close interpersonal relationships with clients, and demonstrated trustworthiness and professionalism. Some clients reported that community members trusted the authenticity of CHWs, while others expressed concerns about the CHWs' ability to maintain confidentiality, and felt that some community members would be uncomfortable receiving HIV services from them. CHWs valued the expansion of their role to include prevention services but expressed concerns about balancing competing demands of CHW responsibilities, income-generating activities, and family roles. CHWs were well accepted as HIV prevention service providers despite contextual challenges. CHWs need ongoing training support. Establishing structures for remunerating CHWs in health systems could improve their performance and retention.