Training Of Health Providers Research Articles

Building Community Capacity to Care for Military and Veteran Families: The Star Behavioral Health Providers Program

Service members, veterans, and their families frequently have difficulties finding trained behavioral health providers who have knowledge of military culture and issues specific to the military population. This paper documents the design, implementation, effectiveness, and proximal outcomes of the Star Behavioral Health Providers training program (SBHP). We created SBHP as a dissemination effort in response to elevated levels of mental health problems among community-dwelling military and veteran families (CDMVF), limitations in provider capacity in the Departments of Defense (DoD) and Veterans Affairs (VA), and uneven preparation of civilian providers to serve military and veteran families. The goals of the initiative were to: Improve the preparation of community-based professionals to work with CDMVF. Increase providers’ use of evidence-informed information and practices. Strengthen the behavioral health infrastructure for treating CDMVF. The program provides military-specific training to community-based behavioral health providers and provides a mechanism for those seeking such services to find trained providers. Evaluation data, though limited by the lack of comparison or control groups, provided correlational evidence consistent with each program goal.

Poor linkage to care for HIV-positive OVC with disabled caregivers: a longitudinal study in Tanzania

BackgroundDespite extensive efforts to scale up counseling and testing services and care and treatment clinics (CTCs) in Tanzania, linkage between points of diagnosis and CTCs remains low. Studies have looked at barriers such as lack of trained health providers, poor referral system, economic costs or distance to health facilities, but fewer assessed the association between caregivers’ vulnerability such as disability and linkage of orphans and vulnerable children (OVCs) in their care to health facilities. This study describes the magnitude of caregivers’ disability and assesses its relationship with successful linkage to care of their OVC living with HIV/AIDS in Tanzania.MethodsData for this analysis came from the USAID Kizazi Kipya project in 79 councils of Tanzania. Data on HIV risk, service use and ART adherence among OVC aged 0–19 years were collected during the project’s quarterly routine data collection (Oct 2017-Sep 2018). Characteristics of caregivers were collected during the project beneficiary screening and enrollment process. Generalized estimating equation models were used to analyze the factors that are associated with linkage of 14,538 HIV positive OVC to CTC, who were taken care of by 11,834 caregivers.ResultsThe majority of caregivers (70%) were females, had completed primary education (67%), 54% were married or cohabiting. Of all the OVC, 3% were living with disabled caregivers; of whom 89% were physically disabled while 11% were mentally disabled. OVCs living with disabled caregivers were less likely to be linked to care (OR 0.76, 95% CI 0.58, 0.99). Factors positively associated with OVC linkage to care were high caregivers’ education level (OR 1.99, 95% CI 1.51, 2.63) and OVC living with a HIV positive caregivers (OR 1.25, 95% CI 1.12, 1.41). OVC living in household with high socio-economic status were less likely to be linked to care (OR 0.76, 95% CI 0.67, 0.86) than those in low-SES households.ConclusionThese results suggest HIV positive OVC living with disabled caregivers had poor linkage to care. The findings highlighted the need to focus attention to the disabilities-led household to promote inclusion and improve access to the HIV services.

Pediatric Medical Emergencies and Injury Prevention Practices in the Pediatric Emergency Unit of Kenyatta National Hospital, Nairobi, Kenya.

The epidemiology and presence of pediatric medical emergencies and injury prevention practices in Kenya and resource-limited settings are not well understood. This is a barrier to planning and providing quality emergency care within the local health systems. We performed a prospective, cross-sectional study to describe the epidemiology of case encounters to the pediatric emergency unit (PEU) at Kenyatta National Hospital in Nairobi, Kenya; and to explore injury prevention measures used in the population. Patients were enrolled prospectively using systematic sampling over four weeks in the Kenyatta National Hospital PEU. Demographic data, PEU visit data and lifestyle practices associated with pediatric injury prevention were collected directly from patients or guardians and through chart review. Data were analyzed with descriptive statistics with stratification based on pediatric age groups. Of the 332 patients included, the majority were female (56%) and 76% were under 5 years of age. The most common presenting complaints were cough (40%) fever (34%), and nausea/vomiting (19%). The most common PEU diagnoses were upper respiratory tract infections (27%), gastroenteritis (11%), and pneumonia (8%). The majority of patients (77%) were discharged from the PEU, while 22% were admitted. Regarding injury prevention practices, the majority (68%) of guardians reported their child never used seatbelts or car seats. Of 68 patients that rode bicycles/motorbikes, one reported helmet use. More than half of caregivers cook at potentially dangerous heights; 59% use ground/low level stoves. Chief complaints and diagnoses in the PEU population were congruent with communicable disease burdens seen globally. Measures for primary injury prevention were reported as rarely used in the sample studied. The epidemiology described by this study provides a framework for improving public health education and provider training in resource-limited settings.

Update on early warning scores.

Early warning scores (EWS) have the objective to provide a preventive approach for detecting those patients in general wards at risk of deterioration before it begins. Well implemented and combined with a tiered response, the EWS expect to be a relevant tool for patient safety. Most of the evidence for their use has been published for the general EWS. Their strengths, such as objectivity and systematic response, health provider training, universal applicability and automatization potential need to be highlighted to counterbalance the weakness and limitations that have also been described. The near future will probably increase availability of EWS, reliability and predictive value through the spread and acceptability of continuous monitoring in general ward, its integration in decision support algorithms with automatic alerts and the elaboration of temporal vital signs patterns that will finally allow to perform a personal modelling depending on individual patient characteristics.

Položaj i potrebe transrodnih i rodno nebinarnih osoba u Srbiji

Transgender and non-binary people are one of the most marginalized groups in the society, exposed to different forms of violence and discrimination, both on the structural and individual level. The aim of our research is to provide a better understanding of the position of transgender and non-binary people in Serbia. In addition to overall socio-demographic characteristics, we explore the experiences of violence and discrimination in public space, during education, at work, as well as the difficulties with legal gender recognition, experiences within the health care system and needs for different forms of support. In this explorative study we used an online questionnaire consisting of closed and open-ended questions. The convenience sample comprised 71 respondents and included both transgender men and women and the non-binary people. Our results confirm that transgender people in Serbia are exposed to violence and discrimination in different life periods and different areas of life, that they do not feel safe and often hide their gender identity. When it comes to medical gender affirmation procedures, respondents are divided between rating them as satisfactory and non-satisfactory. As the main priorities, they see the regulation of hormone shortage, training of health providers on working with transgender and nonbinary people, individualization of the treatment, and decentralization of services. They also voice out the need for psychological support, which can be regarded as an invitation to mental health experts to work towards a better understanding of the specific aspects of everyday lives of their transgender clients.

Supplemental Material for Online Training of Behavioral Health Providers for Primary Care Practice

Supplemental Material for Online Training of Behavioral Health Providers for Primary Care Practice

Evaluation of a Systems-Wide Telebehavioral Health Training Implementation in Response to COVID-19.

In response to the Coronavirus disease 2019 pandemic, it became important to rapidly train mental health providers to provide telebehavioral health services (TBH) within a pediatric care setting. This study examined the perceived usefulness of various TBH training materials; provider motivation, comfort, and confidence in implementation of TBH services; and perceived benefits and barriers of TBH. After completing various training options and implementing TBH services for 1 month, providers indicated all training materials were helpful, with the recorded webinar being identified as the most helpful resource. This study describes the rapid training of mental health providers in preparation of system-wide TBH services.

The Human Need for Recognition

The Human Need for Recognition Elizabeth Flanagan (bio) How lovely to see an article co-authored by a person with schizophrenia and his psychiatrist! For hundreds of years, the perspectives of people receiving services (PRS) was never published in medical/psychiatric journals. Then, some journals had a special section for "voices of lived experience" where people receiving services could write short, personal pieces—often they told dark and negative stories about all the pain they have experienced. Later, people with lived experience were on research teams and people with mental health challenges would be co-authors (Hutchinson & Lovell, 2013). Then research projects were designed and led by people with mental health challenges (Sweeney, Beresford, Faulkner, Nettle, & Rose, 2009). Now the language has moved to "lived expertise" to acknowledge the considerable and important and essential expertise of people living with mental health challenges—in clinical situations, in research contexts, for training and education of mental health providers (Oliver & Cataldo, 2019). And here we have a two-authored article by a "patient" (self-described) and his "psychiatrist." And the "patient" is the first author! I particularly appreciate that the first author was willing to share in detail about his experiences with schizophrenia. Although agreedly atypical from a DSM point of view, they are also similar to what I have heard in my clinical experience. Some people do not want to get rid of their voices, even if the voices say critical things, and they feel a real sense of loss when medication takes away their voices. His description of how his family perceived his inability to continue school and refusal to work as laziness (even going so far as taking him to court—quite extreme!) was also striking. In a study colleagues and I conducted several years ago where we asked people diagnosed with schizophrenia to describe their experiences, people also described that hearing voices and thinking unusual thoughts was so engrossing that it was hard to do anything else (Flanagan et al., 2012). Apparently, what is interpreted in psychiatry as "negative symptoms" are actually not a lack of anything–they are actually very active, engaging effects of hallucination and delusions—it is hard to put sentences together, it is hard to express how you feel, and it is hard to participate in goal-directed behavior like school or work when your voices and thoughts are that intense and engrossing. I know I felt the same way when I had the privilege of doing the Hearing Distressing Voice Similar by Pat Deegan (Deegan, 1996) several years ago—I put on headphones of voices (and they weren't even MY voices who knew all my greatest shames and fears) and tried to go the (virtual) "bank" that is set up as part of the training—I could barely put my thoughts together to discuss the overdraft in my account with the teller given how loud and compelling my voices were. Trying to sustain attention and concentration for even a 10 minute a clinical interview in the "doctor office" section was even harder. [End Page 27] Finally, the loneliness and longing for love and connection—as the first author so aptly put it—"intimacy was out of the question" and "entertainment was always with someone else"—that was universally shared by participants in our study. None of the people described a lack of emotion that is the clinical stereotype with someone with schizophrenia (Andreasen, 1984). In fact, many of our participants also described the dysphoria and despair that the first author described (and in the discussion the question was raised about whether this meant that the first author would be more accurately diagnosed with schizoaffective disorder), but perhaps the despair and mental anguish is a logical and expected emotional reaction to the difficulty of experiencing the symptoms of schizophrenia and being aware of the challenges these symptoms present for the "life" that you have chosen for yourself. Indeed, the author describes it as a "schizophrenic life" and the title of this article is "I am schizophrenic." Labeling yourself as "schizophrenic" can be a tricky thing (Flanagan & Davidson, 2007). On the one hand, the first author describes how embracing his identity as a "schizophrenic...

Reasons for Disparities in Access to Kidney Transplantation.

Clinical Background: Kidney transplantation (KT) is the best treatment for most patients with end-stage kidney disease (ESKD), providing better survival and quality of life and lower cost when compared to dialysis. Epidemiology: Despite robust evidence showing the superiority of KT over dialysis, a significant percentage of ESKD patients worldwide do not access this treatment. Challenges: Barriers resulting in inequalities and inequities in access to KT involves chronic kidney disease (CKD) diagnosis and management, including difficulties in accessing dialysis therapy before KT; suboptimal referral and enlistment to KT; and imbalance between supply and demand for organs. Low socioeconomic status has an important role in that scenario. Prevention and Treatment: Strategies to minimize disparities in access to KT involve public policies to ensure access to CKD diagnosis and treatment, health education, continuous training of health providers, infrastructure, and allocation policies.

Evaluating the integration of tuberculosis screening and contact investigation in tuberculosis clinics in Ethiopia: A mixed method study.

BackgroundAligned with global childhood tuberculosis (TB) road map, Ethiopia developed its own in 2015. The key strategies outlined in the Ethiopian roadmap are incorporating TB screening in Integrated Maternal, Neonatal and Child Illnesses (IMNCI) clinic for children under five years (U5) and intensifying contact investigations at TB clinic. However, these strategies have never been evaluated.ObjectiveTo evaluate the integration of tuberculosis (TB) screening and contact investigation into Integrated Maternal, Neonatal and Child Illnesses (IMNCI) and TB clinics in Addis Ababa, Ethiopia.MethodsThe study used mixed methods with stepped-wedge design where 30 randomly selected health care facilities were randomized into three groups of 10 during August 2016-November 2017. The integration of TB screening into IMNCI clinic and contact investigation in TB clinic were introduced by a three-day childhood TB training for health providers. An in-depth interview was used to explore the challenges of the interventions and supplemented data on TB screening and contact investigation.ResultsOverall, 180896 children attended 30 IMNCI clinics and145444 (80.4%) were screened for TB. A total of 688 (0.4%) children had presumptive TB and 47(0.03%) had TB. During the pre-intervention period, 51873 of the 85278 children (60.8%) were screened for TB as compared to 93570 of the 95618 children (97.9%) in the intervention (p<0.001). This had resulted in 149 (0.30%) and 539 (0.6%) presumptive TB cases in pre-intervention and intervention periods (p<0.001), respectively. Also, nine TB cases (6.0%) in pre-intervention and 38 (7.1%) after intervention were identified (p = 0.72). In TB clinics, 559 under-five (U5) contacts were identified and 419 (80.1%) were screened. In all, 51(9.1%) presumed TB cases and 12 (2.1%) active TB cases were identified from the traced contacts. TB screening was done for 182 of the 275 traced contacts (66.2%) before intervention and for 237 of the 284 of the traced (83.5%) under intervention (p<0.001). Isoniazid prevention therapy (IPT) was initiated for 69 of 163 eligible contacts (42.3%) before intervention and for 159 of 194 eligible children (82.0%) under intervention (p<0.001). Over 95% of health providers indicated that the integration of TB screening into IMNCI and contact investigation in TB clinic is acceptable and practical. Gastric aspiration to collect sputum using nasogastric tube was reported to be difficult.ConclusionsIntegrating TB screening into IMNCI clinics and intensifying contact investigation in TB clinics is feasible improving TB screening, presumed TB cases, TB cases, contact screening and IPT coverage during the intervention period. Stool specimen could be non-invasive to address the challenge of sputum collection.

Adapting a Behavioral Intervention for Alcohol Use and HIV Medication Adherence for Lay Counselor Delivery in Cape Town, South Africa: A Case Series

Human immunodeficiency virus (HIV) and problematic alcohol use are two ongoing and interconnected epidemics in South Africa, with untreated problematic alcohol use associated with poorer HIV treatment outcomes and disease progression. A lack of trained mental health providers is a primary barrier to increasing access to evidence-based treatment in this setting. To address this gap, we integrated evidence-based intervention components for problematic alcohol use and antiretroviral therapy (ART) adherence, adapted for lay provider delivery in an HIV primary care setting in Cape Town, South Africa. The intervention, locally termed “Khanya” in isiXhosa, which means glow, direction, or light, comprises Life Steps adherence counseling, motivational interviewing, behavioral activation, and relapse prevention, including mindfulness-based relapse prevention components. In this case series, we present a detailed description of the intervention and provide three clinical cases of individuals who received the Khanya intervention to showcase necessary clinical adaptations and the supervision needed for optimal treatment delivery, flexibility in intervention delivery, and overall successes and challenges. We present descriptive data on alcohol use and ART adherence outcomes for the cases to supplement the narrative discussion. Successes of intervention delivery included participant uptake of mindfulness skills, reductions in alcohol use despite varying levels of motivation, and interventionist mastery over various clinical skills. Challenges included delivering the intervention within the allotted time and the strong influence of substance-using social networks. Overall, a pragmatic approach to intervention delivery was necessary, as was ongoing support for the interventionist to promote fidelity to both treatment components and therapeutic skills.Trial registration: ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018.

Factors associated with the uptake of immediate postpartum intrauterine contraceptive devices (PPIUCD) in Rwanda: a mixed methods study

BackgroundRwanda has a high unmet need for family planning which could be reduced by improving access to postpartum intrauterine contraceptives device (PPIUCD) insertion. The objective of the study was to assess the prevalence and factors associated with the uptake of PPIUCD among postpartum women in Muhima Hospital.MethodsA concurrent mixed-method study was used. Three hundred eight three (383) immediate postpartum mothers, and 10 health services providers were interviewed using a structured questionnaire and in-depth interviews respectively. Logistics regression was done to assess for factors associated with PPIUCD uptake and thematic analysis was used for qualitative data.ResultsThe prevalence for PPIUCD use was 28.1%, women who had spontaneous vaginal delivery were more likely to take up PPIUCD (Adjusted Odds Ratio (AOR) 2.623, 95% CI = 2.017–6.507 compared to those who had cesarean section; women who received PPIUCD counselling during the antenatal period were more likely to use PPIUCD ((AOR 2.072, 95% CI = 1.018–4.218) as compared to those who didn’t receive any form of counselling; mothers who received spouse approval were more likely to use PPIUCD (AOR 2.591,95% CI = 1.485–4.492); as compared to those who didn’t receive any spousal approval; women who had more than one child were more likely to use PPIUCD (AOR =2.265, 95% CI = 1.472–3.163) as compared to prime gravida; Mothers with birth to pregnancy interval less than two years were more likely to use PPIUCD (AOR =2.123, CI =1.477–2.706) as compared to those who had birth to pregnancy interval more than 2 years. From the qualitative findings, health education of mothers and partners on PPIUCD, training of health care providers, and availability of supplies to provide PPIUCD influenced the use of PPIUCD.ConclusionThe acceptability to use for PPIUCD was high in this population. PPIUCD uptake was associated with normal birth, PPIUCD counselling, spousal approval, parity, birth interval, level of education. Health education of mothers and partners on PPIUCD, training of health providers, and availability of supplies to provide PPIUCD influenced uptake of PPIUCD.

Structural Barriers to Health-provider Training Programmes for Ethnic Minorities: The Case of the Katu and Diabetes Management in Vietnam

Background: Training of primary care practitioners is one of the most implemented interventions in medical international development programmes targeting non-communicable diseases (NCD). Yet in many cases their effectiveness is below expectations. One potential cause of this is that they struggle to account for local context, especially when working with ethnic minorities. Here we begin to address this gap through a qualitative case-study of how local contextual factors have impacted the success of a World Health Organization (WHO) healthcare training programme on Type 2 diabetes with an ethnic minority group in rural central Vietnam.&#x0D; Design: A qualitative case-study collected data during 2018. We conducted 25 semi-structured interviews, two focus groups, and participant observation with patients, healthcare professionals, and members of a local non-governmental organisation involved in the programme. We used thematic coding to identify important contextual factors and how they helped or hindered programme delivery. Next, we synthesised each of these themes in a narrative style, drawing on the rich detail provided by respondents.&#x0D; Results: We found that, despite using a notionally decentralised approach, the effectiveness of the training was hindered by social, political, and economic determinants of health which influenced the inhabitants’ relations to healthcare and diabetes. Particular barriers were the political perceptions of minorities, their economic access to services, the healthcare prejudices toward ethnic rural populations and the rigidity of medical training.&#x0D; Conclusions: Given the similarity of our case with other WHO NCD programmes, we view that our findings are of wider relevance to global public health policy and practice. We suggest that better recognising and addressing local contextual factors would make such programmes more polyvocal, grounded, and resilient, as well as enabling them to better support long-term transformative change in public health systems. We conclude by discussing methods for implementing this in practice.

Chat-based hotlines for health promotion: a systematic review

Chat-based hotlines use online messaging services or popular chat applications such as WhatsApp, Facebook Messenger, and WeChat, to connect users to trained health providers or staff. Chat-based hotlines can provide real-time communication between health providers and patients. The evidence for chat-based hotlines for health promotion has not been reviewed systematically. Electronic databases (PubMed, Cochrane Database, Google Scholar) were searched to identify English-language studies describing original research published from 2009 to 2020. This review was registered with Prospero Register of Systematic Reviews (ID: CRD42020156670). Twelve publications met our criteria. Ten studies reported on user characteristics, eight on comparing use of chat-based hotlines with different modes of support, six on health outcomes and six on user satisfaction. Included studies report that chat-based hotlines have been used primarily for crisis and emotional support in high-income countries. Chat-based hotlines using instant messenger applications were preferred over other modes of services such as email, text messaging, voice calls, and face-to-face counselling. Evaluations of health outcomes, although limited in rigor due to mostly observational study designs, indicate mostly positive and statistically significant effects on mental health outcomes such as anxiety, depression, well-being and suicidality. User satisfaction with chat-based hotlines were moderately high. Chat-based hotlines may be effective ways to deliver crisis support services in high income settings. They may have the potential to be effective in low- and middle-income countries to expand the reach of mental health and crisis support services although such services have not yet been publicly evaluated.

Standardized assessment domains as predictors of prescription of trauma-focused treatment for youth in out-of-home care

Abstract It has long been recognized that youth entering out-of-home care have traumatic experiences and their associated effects on emotional and behavioral wellbeing may be unrecognized, overlooked, or untreated. An assessment to identify youth needs is vital as an initial step to youth in out-of-home care receiving needed treatment. Standardized assessments in particular can serve as an effective starting point in addressing the needs of these youth. This study explored if domains of the Child and Adolescent Needs and Strengths assessment were associated with a prescribed trauma-focused treatment. Bivariate and multivariate analyses were conducted utilizing a cross-section of child welfare involved youth who were part of the out-of-home care system and received a CANS assessment. Results from this study suggest the most predictive CANS domains were ‘emotional behavioral needs’ followed by ‘caregiver/ needs and strengths’. There was a sizeable portion of youth in the study with identified trauma-related symptoms who were not prescribed a trauma-focused treatment; which is consistent with prior research and suggests traumatized youth in out-of-home care are undertreated. More investigation of youth who have been assessed to have trauma-related needs, but who have not been assigned a trauma-focused treatment is needed. Findings have training and supervision implications for child welfare and behavioral health providers, and can aid in understanding the characteristics and needs of the youth served. Using similar language from standardized assessments allow child welfare and behavioral health workers to better communicate and collaborate to serve youth. Findings from this study promote evidence-informed practice in child welfare and behavioral health in order to better serve children and families.

Launching a Competency-Based Training Program in Evidence-Based Treatments for PTSD: Supporting Veteran-Serving Mental Health Providers in Texas.

Community mental health providers play an essential role in delivering services to veterans who either have limited access to U.S. Department of Veterans Affairs (VA) facilities or who prefer to seek care outside of the VA. However, there are limited training opportunities in evidence-based treatments for posttraumatic stress disorder (PTSD) outside of the VA. In 2017, the STRONG STAR Training Initiative was established to develop competency-based training in two evidence-based therapies for PTSD and to provide that training for mental health providers serving veterans and their families in community settings in Texas. This article describes the program's development and implementation, baseline characteristics of participating clinicians, and lessons learned toward the scale-up and extension of this competency-based training effort to include other interventions and locations.

Complications of therapeutic plasma exchange in patients with neurological disorders

Background: Therapeutic plasma exchange (TPE) is the treatment of choice for many neurologic disorders. The safety of this procedure is a major concern for physicians. The aim of this study was to determine the complications of TPE in patients with neurologic disorders at a tertiary referral hospital. Methods: This retrospective cross-sectional study evaluated patients with various neurologic disorders receiving TPE in neurology department of Shariati Hospital, Tehran, Iran. Major and minor complications related to TPE were recorded. Results: Clinical information records of 417 TPE sessions (88 patients) were available. Mean age of patients was 40.0 ± 15.8 years. Underlying diseases included central demyelinating disorders, myasthenia gravis (MG), chronic neuropathy, Guillain-Barre syndrome (GBS), and autoimmune encephalopathy in 34.1%, 33.0%, 17.0%, 14.8%, and 1.1% of patients, respectively. Major complications occurred in 15.9% of patients and 37.5% of patients accounted for minor complications. Among major adverse effects, thrombosis, infection, and lifethreatening complications were seen more commonly in patients with central vascular access (P = 0.005, P = 0.003, and P = 0.010, respectively). Conclusion: TPE complications were seen more commonly in patients with central vascular access. Therefore, use of peripheral vascular access and vigilant patient monitoring by trained health providers can reduce its complications.

Digital Health Equity and COVID-19: The Innovation Curve Cannot Reinforce the Social Gradient of Health.

Digital health innovations have been rapidly implemented and scaled to provide solutions to health delivery challenges posed by the coronavirus disease (COVID-19) pandemic. This has provided people with ongoing access to vital health services while minimizing their potential exposure to infection and allowing them to maintain social distancing. However, these solutions may have unintended consequences for health equity. Poverty, lack of access to digital health, poor engagement with digital health for some communities, and barriers to digital health literacy are some factors that can contribute to poor health outcomes. We present the Digital Health Equity Framework, which can be used to consider health equity factors. Along with person-centered care, digital health equity should be incorporated into health provider training and should be championed at the individual, institutional, and social levels. Important future directions will be to develop measurement-based approaches to digital health equity and to use these findings to further validate and refine this model.

Interventions on Women Under Intimate Partner Violence: An Integrative Review

The present study is aimed to determine the interventions on women under intimate partner violence. This integrative review was performed by searching in international (Web of science, PubMed, Scopus Science direct, and EMBASE) and national (SID and magiran) databases were searched from inception to December 31, 2018. The keywords used included “interventions” OR “IPV” OR “intimate partner violence”. The search of studies, data extraction and screening conducted by two researcher. Of 2782 studies 30 studies included in final stage. These studies were mainly investigated the effect of the intervention type on domestic violence against women. Of these, 17 studies focused on victims of domestic violence, of which 7 focused on supporting and empowering victims of violence, and 7 were interventional studies, and the remaining 3 studies were online and computer-based interventions. Another category of interventions focused on training and empowerment of health professionals and providers (7 studies), and two studies focused on both groups of DV victims and care providers. In addition to the DV victims and care providers, 4 studies included community factors in interventions. It also seems that carrying out comprehensive and adequate interventions on women under domestic violence is needed

Perceptions matter: Narratives of contraceptive implant robbery in Cape Town, South Africa

Uptake of contraceptive implants has declined in South Africa since their introduction in 2014, with side effects and inadequate health provider training cited as primary contributors underlying a poor community perception of implants. In this paper we explore a theme that emerged unexpectedly during analysis of our research in Cape Town that may be an additional factor in this decline: narratives of women being assaulted by robbers who physically remove the implants for smoking as drugs. Narratives were described consistently across interviews and focus groups with youth (aged 18–24 years) and in interviews with health providers, with six participants (two young people, four health providers) sharing personal experiences of robbery. While there was a range of perspectives on whether narratives are based on real experiences or are myths, there was strong consensus that narratives of implant robbery may be influencing women’s decisions around implant use in Cape Town. This is a potent example of how perceptions of new products can affect uptake and offers important lessons for implementers to reflect on in planning for rollout of other health technologies.